Provider Demographics
NPI:1992709620
Name:TAYLOR, WALTER L III (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:L
Last Name:TAYLOR
Suffix:III
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 1:6701 HERITAGE PKWY
Mailing Address - Street 2:STE 110
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8799
Mailing Address - Country:US
Mailing Address - Phone:972-412-8700
Mailing Address - Fax:972-412-9700
Practice Address - Street 1:6701 HERITAGE PKWY
Practice Address - Street 2:STE 110
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8799
Practice Address - Country:US
Practice Address - Phone:972-412-8700
Practice Address - Fax:972-412-9700
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2023-02-20
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-16
Provider Licenses
StateLicense IDTaxonomies
TXJ93782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035932501Medicaid
TX2277317OtherAETNA
TX85700GOtherBCBS
TX2277317OtherAETNA
TXG14314Medicare UPIN