Provider Demographics
NPI:1447256193
Name:TAYLOR, HARRY B (PA-C)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:B
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-4945
Mailing Address - Country:US
Mailing Address - Phone:405-794-4474
Mailing Address - Fax:405-793-8703
Practice Address - Street 1:320 N SERVICE RD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-4945
Practice Address - Country:US
Practice Address - Phone:405-794-4474
Practice Address - Fax:405-793-8703
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA229363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1447256193OtherNPI
1447256193OtherNPI