MEDICARE: SUSAN JANE TAYLOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	E6969	TX
2	207RH0000X	Hematology (Internal Medicine) Physician	E6969	TX
3	207RX0202X	Medical Oncology Physician	E6968	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00175170	OTHER	TX	RR MEDICARE INDIVIDUAL #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8P5870	OTHER	TX	BCBS INDIVIDUAL NUMBER

General Provider Information

NPI Number	:	1073520250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN JANE TAYLOR M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1315
Second Line	:
City	:	DEL RIO
State	:	TX
Zip	:	78841-1315
Country	:	US
Telephone Number	:	830-775-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 AVENUE G
Second Line	:
City	:	DEL RIO
State	:	TX
Zip	:	78840-3627
Country	:	US
Telephone Number	:	830-775-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	03/09/2023

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Directions to “ SUSAN JANE TAYLOR M.D.” Practice Location

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