Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 2010040490 | MO |
N | 207V00000X | Obstetrician & Gynecologist | 58002034 | OH |
N | 207VG0400X | Gynecologist | 2010040490 | MO |
NPI | 1093910671 |
---|---|
Provider Name | Selma J Taylor |
First Address | Ava, MO 65608-1359 |
Second Address | Ava, MO 65608-1359 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 12/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2010040490 | STATE LICENSE (01) | MO |
58002034 | MEDICAL LICENSE (01) | OH |