Provider Demographics
NPI:1831264936
Name:TAYLOR, RICHARD N JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:N
Last Name:TAYLOR
Suffix:JR
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 1:310 WENDELL AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2267
Mailing Address - Country:US
Mailing Address - Phone:406-535-6254
Mailing Address - Fax:406-535-6237
Practice Address - Street 1:310 WENDELL AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2267
Practice Address - Country:US
Practice Address - Phone:406-535-6254
Practice Address - Fax:406-535-6237
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4660207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000061698Medicaid
MT01556-0OtherBLUE CROSS BLUE SHIELD MT
MTM000001556Medicare PIN
MTC59737Medicare UPIN