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General NPI Number Information
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NPI Number | 1780064568
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Entity Type | Individual
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Provider Name | JOCK NEIL TAYLOR M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2015
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 5901 E ROYALTON RD STE 1400
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-3532
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Country | US
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Telephone | 440-792-9055
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Fax | 216-201-8910
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Provider Business Mailing Address
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Address Line | 1 INFINITY CORPORATE CENTRE DR STE 160
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-5374
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Country | US
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Telephone | 216-581-5555
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Fax | 216-581-2094
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | LL38312
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 35.133468
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License Number State | OH
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