Provider Demographics
NPI:1194962217
Name:TAYLOR, JAMES BRADFORD (PA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BRADFORD
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1090 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-3039
Mailing Address - Country:US
Mailing Address - Phone:910-875-4545
Mailing Address - Fax:910-875-8972
Practice Address - Street 1:1090 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3039
Practice Address - Country:US
Practice Address - Phone:910-875-4545
Practice Address - Fax:910-875-8972
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2012-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-01651363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant