Healthcare Provider Details

I. General information

NPI: 1528054145
Provider Name (Legal Business Name): JON C TAYLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ARROW SPRINGS BLVD
LEBANON OH
45036-7002
US

IV. Provider business mailing address

1472 SOLUTIONS CTR
CHICAGO IL
60677-1004
US

V. Phone/Fax

Practice location:
  • Phone: 513-282-7075
  • Fax:
Mailing address:
  • Phone: 513-557-3333
  • Fax: 513-557-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.089274
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: