Provider Demographics
NPI:1053334797
Name:TAYLOR, PHILIP W (MD, FACP)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:W
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 843225
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3225
Mailing Address - Country:US
Mailing Address - Phone:708-633-1234
Mailing Address - Fax:708-342-7100
Practice Address - Street 1:3250 GORDONVILLE RD
Practice Address - Street 2:STE 301
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5056
Practice Address - Country:US
Practice Address - Phone:573-334-9641
Practice Address - Fax:573-331-3120
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5645207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1053334797Medicaid
MO603522OtherANTHEM BCBS
173594OtherHEALTHLINK
MO201877826Medicaid
MOP00779931OtherRR MCR
173594OtherHEALTHLINK
MO201877826Medicaid