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NPI Code Detail

MEDICARE: CHARLES MICHAEL TAYLOR II

MEDICARE: CHARLES MICHAEL TAYLOR II
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
1208100000XPhysical Medicine & Rehabilitation PhysicianS4403TX

General Provider Information

NPI Number : 1538553417
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES MICHAEL TAYLOR II
Provider Business Mailing Address
First Line : 539 W COMMERCE ST
Second Line : STE 3000
City : DALLAS
State : TX
Zip : 75208-1953
Country : US
Telephone Number : 214-970-6817
Fax Number : 844-803-4513
Provider Business Practice Location Address
First Line : 300 E BAKER ST
Second Line :
City : CLARKSVILLE
State : TX
Zip : 75426-5034
Country : US
Telephone Number : 903-427-2236
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2015
Last Update Date : 07/13/2020

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