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General NPI Number Information
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NPI Number | 1457585960
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Entity Type | Organization
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Legal Business Name | LUIS GLENN TAYLOR, M.D., P.A.
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 740 HOSPITAL DR SUITE 160
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City | BEAUMONT
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State | TX
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Zip | 77701-4664
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Country | US
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Telephone | 409-832-6188
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Fax | 409-839-4760
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Provider Business Mailing Address
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Address Line | 740 HOSPITAL DR SUITE 160
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City | BEAUMONT
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State | TX
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Zip | 77701-4664
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Country | US
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Telephone | 409-832-6188
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Fax | 409-839-4760
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. LUIS GLENN TAYLOR GLENN TAYLOR
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Credential | M.D.
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Telephone | 409-832-6188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | J8394
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License Number State | TX
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