Provider Demographics
NPI:1194795906
Name:TAYLOR, HENRY J III (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:J
Last Name:TAYLOR
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-764-3335
Mailing Address - Fax:206-764-0489
Practice Address - Street 1:3010 STATE ROUTE 109
Practice Address - Street 2:
Practice Address - City:COPALIS BEACH
Practice Address - State:WA
Practice Address - Zip Code:98535-0339
Practice Address - Country:US
Practice Address - Phone:360-289-2427
Practice Address - Fax:360-289-9982
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-065592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0945Medicaid
OH0792204Medicare ID - Type UnspecifiedMEDICARE #
OH0945Medicaid