Provider Demographics
NPI:1144285156
Name:TAYLOR, KENNETH K (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:K
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7104 UNIVERSITY CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8045
Mailing Address - Country:US
Mailing Address - Phone:334-395-5800
Mailing Address - Fax:334-395-5880
Practice Address - Street 1:7104 UNIVERSITY CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8045
Practice Address - Country:US
Practice Address - Phone:334-395-5800
Practice Address - Fax:334-395-5880
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00008631204C00000X
AL8637174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C75527Medicare UPIN
ALC75527Medicare UPIN