Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 13304 | MS |
N | 2080P0203X | Pediatric Critical Care Doctor | 28959 | TN |
NPI | 1174629257 |
---|---|
Provider Name | Mary B Taylor |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 18/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
370019646 | RR MEDICARE (01) | |
38418511 | (05) | TN |
3841852 | (05) | TN |
4019556 | BCBS (01) |