Provider Demographics
NPI:1811962509
Name:TAYLOR, THOMAS KENT (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:KENT
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 MEDICAL CENTER PKWY STE 305
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-7738
Mailing Address - Country:US
Mailing Address - Phone:334-418-4113
Mailing Address - Fax:
Practice Address - Street 1:905 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6746
Practice Address - Country:US
Practice Address - Phone:334-874-6053
Practice Address - Fax:334-418-0726
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9217207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051075573OtherBCBS OF ALABAMA
ALTA000006131Medicaid
AL051517691OtherBCBS OF ALABAMA
AL406393129OtherMEDICARE RAILROAD PROV #
AL051006131OtherBLUE CROSS PROVIDER #
ALTA000075573Medicaid
ALTA009931425Medicaid
AL051517691OtherBCBS OF ALABAMA
ALTA000075573Medicaid
ALTA000006131Medicaid
AL0000005679Medicare NSC