Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 036060997 | IL |
NPI | 1003924127 |
---|---|
Provider Name | Dr. Lyndon D Taylor |
First Address | Oak Park, IL 60302-1205 |
Second Address | Oak Park, IL 60302-1205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 09/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036060997 | (05) | IL |
D15980 | (02) |