MEDICARE: DR. JAMES DREW TAYLOR DPM

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	213E00000X	Podiatrist	016004852	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6242980001	OTHER	IL	DME PTAN

General Provider Information

NPI Number	:	1659449965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES DREW TAYLOR DPM

Provider Business Mailing Address
First Line	:	4905 STONE FALLS CTR STE B
Second Line	:
City	:	O FALLON
State	:	IL
Zip	:	62269-7802
Country	:	US
Telephone Number	:	618-277-0001
Fax Number	:	618-277-7339

Provider Business Practice Location Address
First Line	:	4905 STONE FALLS CTR STE B
Second Line	:
City	:	O FALLON
State	:	IL
Zip	:	62269-7802
Country	:	US
Telephone Number	:	618-277-0001
Fax Number	:	618-277-7339

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	02/17/2023

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