MEDICARE: DR. KENNETH K 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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	00008631	AL
2	174400000X	Specialist	8637	AL

General Provider Information

NPI Number	:	1144285156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH K TAYLOR M.D.

Provider Business Mailing Address
First Line	:	7104 UNIVERSITY CT
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-8045
Country	:	US
Telephone Number	:	334-395-5800
Fax Number	:	334-395-5880

Provider Business Practice Location Address
First Line	:	7104 UNIVERSITY CT
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-8045
Country	:	US
Telephone Number	:	334-395-5800
Fax Number	:	334-395-5880

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	05/22/2024

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