Provider Demographics
NPI:1871148478
Name:TAYLOR, ROBERT ELLIS III
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ELLIS
Last Name:TAYLOR
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1151
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:IL
Mailing Address - Zip Code:60184-1151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2525 KANEVILLE RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2578
Practice Address - Country:US
Practice Address - Phone:630-584-1400
Practice Address - Fax:833-464-4614
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.007490207XS0117X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine