Healthcare Provider Details

I. General information

NPI: 1447256193
Provider Name (Legal Business Name): HARRY B. TAYLOR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N SERVICE RD
MOORE OK
73160-4945
US

IV. Provider business mailing address

320 N SERVICE RD
MOORE OK
73160-4945
US

V. Phone/Fax

Practice location:
  • Phone: 405-794-4474
  • Fax: 405-793-8703
Mailing address:
  • Phone: 405-794-4474
  • Fax: 405-793-8703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA229
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: