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General NPI Number Information
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NPI Number | 1568697142
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Entity Type | Individual
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Provider Name | JIMMIE MATTHEW TAYLOR MD
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Gender | Male
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 4300 W MEMORIAL RD DEPARTMENT OF RADIOLOGY
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-8304
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Country | US
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Telephone | 405-752-3636
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 95818
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City | OKLAHOMA CITY
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State | OK
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Zip | 73143-5818
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Country | US
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Telephone | 405-632-2327
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD-41675
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 27024
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License Number State | OK
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