Provider Demographics
NPI:1801645528
Name:TAYLOR, JUSTIN MARCUS BUCKLEY (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MARCUS BUCKLEY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:625 POST OAK DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2460
Mailing Address - Country:US
Mailing Address - Phone:682-330-9983
Mailing Address - Fax:
Practice Address - Street 1:789 MINOT AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-3924
Practice Address - Country:US
Practice Address - Phone:207-795-8475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD27904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine