MEDICARE: JOCK NEIL 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	207Q00000X	Family Medicine Physician	LL38312	SC
2	207QS0010X	Sports Medicine (Family Medicine) Physician	35.133468	OH

General Provider Information

NPI Number	:	1780064568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOCK NEIL TAYLOR M.D.

Provider Business Mailing Address
First Line	:	1 INFINITY CORPORATE CENTRE DR STE 160
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-5374
Country	:	US
Telephone Number	:	216-581-5555
Fax Number	:	216-581-2094

Provider Business Practice Location Address
First Line	:	5901 E ROYALTON RD STE 1400
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-3532
Country	:	US
Telephone Number	:	440-792-9055
Fax Number	:	216-201-8910

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

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	11/20/2020

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