Provider Demographics
NPI:1154356475
Name:TAYLOR, EDWARD WILLIAM III
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WILLIAM
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 1:3838 SAN DIMAS ST
Mailing Address - Street 2:BLDG B SUITE B-231
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1494
Mailing Address - Country:US
Mailing Address - Phone:661-665-0505
Mailing Address - Fax:661-665-7844
Practice Address - Street 1:3838 SAN DIMAS ST
Practice Address - Street 2:BLDG B SUITE B-231
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1494
Practice Address - Country:US
Practice Address - Phone:661-665-0505
Practice Address - Fax:661-665-7844
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64244208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G642440Medicare ID - Type Unspecified
F17327Medicare UPIN