Provider Demographics
NPI:1962568394
Name:TAYLOR, EDWARD CALHOUN (PHD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CALHOUN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8382 BAYMEADOWS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7436
Mailing Address - Country:US
Mailing Address - Phone:904-886-9006
Mailing Address - Fax:904-886-4060
Practice Address - Street 1:3750 SAN JOSE PL
Practice Address - Street 2:SUITE 35
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8858
Practice Address - Country:US
Practice Address - Phone:904-886-9006
Practice Address - Fax:904-886-4060
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3397103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038449Medicare UPIN