Provider Demographics
NPI:1538152475
Name:TAYLOR, JAMES ROBERT (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
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 1:2121 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2922
Mailing Address - Country:US
Mailing Address - Phone:253-301-6850
Mailing Address - Fax:
Practice Address - Street 1:2121 S 19TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2922
Practice Address - Country:US
Practice Address - Phone:253-301-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020902207RC0200X, 207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1120187Medicaid
WA290002566OtherRR MEDICARE
WAG001001762-PIERCE COMedicare PIN
WA290002566OtherRR MEDICARE
WAA53321Medicare UPIN