Healthcare Provider Details

I. General information

NPI: 1649205089
Provider Name (Legal Business Name): PAUL E. TAYLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 ST. ANDREWS LANE
BOOTHBAY HARBOR ME
04538-1732
US

IV. Provider business mailing address

35 MILES STREET
DAMARISCOTTA ME
04543-4047
US

V. Phone/Fax

Practice location:
  • Phone: 207-633-7820
  • Fax: 207-633-7082
Mailing address:
  • Phone: 207-563-4146
  • Fax: 207-563-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD10271
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: