MEDICARE: ROBERT M TAYLOR

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	208100000X	Physical Medicine & Rehabilitation Physician	09934R	LA
2	208100000X	Physical Medicine & Rehabilitation Physician	12544	MS
3	208100000X	Physical Medicine & Rehabilitation Physician	53520	AZ
4	208100000X	Physical Medicine & Rehabilitation Physician	MD.09934R	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	250004978	OTHER	LA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1295714038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT M TAYLOR

Provider Business Mailing Address
First Line	:	14233 NORTH GOLDEN BARREL PASS
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85658
Country	:	US
Telephone Number	:	318-542-6367
Fax Number	:

Provider Business Practice Location Address
First Line	:	14233 NORTH GOLDEN BARREL PASS
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85658
Country	:	US
Telephone Number	:	318-542-6367
Fax Number	:	318-442-6738

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	11/02/2023

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