Healthcare Provider Details

I. General information

NPI: 1083684534
Provider Name (Legal Business Name): BENJAMIN THOMAS TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12230 ASHEVILLE HWY
INMAN SC
29349-1845
US

IV. Provider business mailing address

PO BOX 2168
SPARTANBURG SC
29304-2168
US

V. Phone/Fax

Practice location:
  • Phone: 864-472-2144
  • Fax: 864-472-4696
Mailing address:
  • Phone: 864-560-4304
  • Fax: 864-560-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6861
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: