Physician Compare National (NPI:1508186990)

HEALTHCARE PROVIDER: DAVID PROVOSTY TAYLOR JR. M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1508186990
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0547409294
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20151002001868
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TAYLOR
	Individual professional last name
Provider First Name	DAVID
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2009
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	GULFPORT OBSTETRICAL AND GYNECOLOGICAL CLINIC, PA
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	6204897689
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	6
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	4502 OLD PASS RD
	Group Practice or individual's line 1 address
City	GULFPORT
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	395012585
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2288639977
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	250019
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEMORIAL HOSPITAL AT GULFPORT
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y