Provider Demographics
NPI:1679004766
Name:LOYAL, JAMESON TAYLOR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMESON
Middle Name:TAYLOR
Last Name:LOYAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9339 GENESEE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2122
Mailing Address - Country:US
Mailing Address - Phone:858-657-1004
Mailing Address - Fax:858-657-9294
Practice Address - Street 1:9339 GENESEE AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2122
Practice Address - Country:US
Practice Address - Phone:858-657-1004
Practice Address - Fax:858-657-9294
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA172871207N00000X
NY307026207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology