Provider Demographics
NPI:1053622498
Name:MATHIS, TAYLOR PHILLIPS (MD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:PHILLIPS
Last Name:MATHIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1211 S GLOSTER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801
Mailing Address - Country:US
Mailing Address - Phone:662-767-4200
Mailing Address - Fax:662-767-4204
Practice Address - Street 1:1211 S GLOSTER ST
Practice Address - Street 2:SUITE A
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801
Practice Address - Country:US
Practice Address - Phone:662-767-4200
Practice Address - Fax:662-767-4204
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2021-02-01
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Provider Licenses
StateLicense IDTaxonomies
MS24399207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07387848Medicaid