Organization
REDLANDS PATHOLOGY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER LEONARD TAYLOR JR. MD (PRESIDENT)
(909) 792-9197
Entity
Organization
Contact information
Practice address
350 TERRACINA BLVD, REDLANDS, CA 92373-4850
(909) 792-9197
(909) 792-1022
Mailing address
8401 JACK FINNEY BLVD, GREENVILLE, TX 75402-3017
(800) 945-2455
(770) 776-5782
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0044310
—
CA
01
—
ZZZ22734Z
BLUE SHIELD
CA
Enumeration date
09/08/2006
Last updated
10/31/2014
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