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General NPI Number Information
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NPI Number | 1003942418
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Entity Type | Organization
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Legal Business Name | RANDOLPH H. TAYLOR, MD, LLC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3510 MEDICAL PARK DR SUITE 3
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City | MONROE
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State | LA
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Zip | 71203-2384
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Country | US
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Telephone | 318-329-8194
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Fax | 318-329-8196
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Provider Business Mailing Address
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Address Line | PO BOX 2898
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City | MONROE
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State | LA
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Zip | 71207-2898
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Country | US
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Telephone | 318-329-8194
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Fax | 318-329-8196
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDOLPH H. TAYLOR
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Credential | M.D.
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Telephone | 318-329-8194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 013943
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License Number State | LA
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