Provider Demographics
NPI:1104926112
Name:TAYLOR, ALICIA C (MD)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:C
Last Name:TAYLOR
Suffix:
Gender:F
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:PO BOX 82632
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-2632
Mailing Address - Country:US
Mailing Address - Phone:504-261-9875
Mailing Address - Fax:
Practice Address - Street 1:1665 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3312
Practice Address - Country:US
Practice Address - Phone:504-261-9875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS3758207V00000X
LA022782207VX0000X
CAC182388207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1482102Medicaid
LA1482102Medicaid
LA5E815Medicare ID - Type Unspecified