Healthcare Provider Details

I. General information

NPI: 1831143619
Provider Name (Legal Business Name): ROBERT E TAYLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 N ROXBORO ST SUITE 140
DURHAM NC
27704-1874
US

IV. Provider business mailing address

4210 N ROXBORO ST SUITE 140
DURHAM NC
27704-1874
US

V. Phone/Fax

Practice location:
  • Phone: 919-620-7800
  • Fax: 919-620-7807
Mailing address:
  • Phone: 919-620-7800
  • Fax: 919-620-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberNC 34749
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberNC34749
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: