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General NPI Number Information
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NPI Number | 1568748721
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Entity Type | Individual
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Provider Name | PHILLIP DAVID TAYLOR SR. MPAS, PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 1210 N RETAMA ST
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City | KINGSVILLE
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State | TX
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Zip | 78363-3496
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Country | US
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Telephone | 361-239-0600
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Fax | 877-550-1895
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Provider Business Mailing Address
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Address Line | 204 E 1ST ST
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City | ALICE
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State | TX
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Zip | 78332-4822
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Country | US
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Telephone | 361-664-0145
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Fax | 361-664-2248
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA07458
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License Number State | TX
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