MEDICARE: JAMES H TAYLOR D.O.

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	OS3908	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790776474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES H TAYLOR D.O.

Provider Business Mailing Address
First Line	:	PO BOX 1357
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-1357
Country	:	US
Telephone Number	:	239-332-0417
Fax Number	:	239-334-9417

Provider Business Practice Location Address
First Line	:	3594 BROADWAY
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8017
Country	:	US
Telephone Number	:	239-344-2330
Fax Number	:	239-332-4701

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	05/05/2010

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