Healthcare Provider Details

I. General information

NPI: 1295893857
Provider Name (Legal Business Name): STANLEY DOUGLAS TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 COUNTRY CLUB RD
JACKSONVILLE NC
28546-6807
US

IV. Provider business mailing address

504 SANAL COURT
JACKSONVILLE NC
28540
US

V. Phone/Fax

Practice location:
  • Phone: 910-347-7773
  • Fax: 910-347-7792
Mailing address:
  • Phone: 910-347-7773
  • Fax: 910-347-7792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23340
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: