Provider Demographics
NPI:1609874775
Name:TAYLOR, GARRY BILL (DO)
Entity type:Individual
Prefix:DR
First Name:GARRY
Middle Name:BILL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2320 HARTS BLUFF RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-7453
Mailing Address - Country:US
Mailing Address - Phone:903-572-1951
Mailing Address - Fax:903-572-2590
Practice Address - Street 1:2320 HARTS BLUFF RD
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-7453
Practice Address - Country:US
Practice Address - Phone:903-572-1951
Practice Address - Fax:903-572-2590
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD7697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L530Medicare ID - Type Unspecified
TXD79665Medicare UPIN