Healthcare Provider Details

I. General information

NPI: 1720281140
Provider Name (Legal Business Name): JAMES MATTHEW TAYLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 VISTA AVE DEPT. OF ANESTHESIOLOGY, DESLOGE TOWERS 3RD FLOOR
SAINT LOUIS MO
63110-0250
US

IV. Provider business mailing address

4400 LINDELL BLVD 15-C
SAINT LOUIS MO
63108-2464
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-8750
  • Fax:
Mailing address:
  • Phone: 314-533-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2004017101
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: