Healthcare Provider Details

I. General information

NPI: 1164690699
Provider Name (Legal Business Name): JAMES A TAYLOR DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 HORTON RD SUITE A
JACKSON MI
49203-5297
US

IV. Provider business mailing address

1331 HORTON RD SUITE A
JACKSON MI
49203-5297
US

V. Phone/Fax

Practice location:
  • Phone: 517-784-4242
  • Fax: 517-784-6943
Mailing address:
  • Phone: 517-784-4242
  • Fax: 517-784-6943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101009480
License Number StateMI

VIII. Authorized Official

Name: DR. JAMES ALLAN TAYLOR
Title or Position: PRESIDENT
Credential: DO
Phone: 517-784-4242