Provider Demographics
NPI:1083021554
Name:TAYLOR, AUSTIN BLAKE (DO)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:BLAKE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-0432
Mailing Address - Country:US
Mailing Address - Phone:606-430-2209
Mailing Address - Fax:606-218-7509
Practice Address - Street 1:911 BYPASS RD BLDG A
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-2624
Practice Address - Country:US
Practice Address - Phone:606-430-2209
Practice Address - Fax:606-218-7509
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102205806207W00000X
KY04355207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0102205806OtherVIRGINIA DEPARTMENT OF HEALTH