Individual
MARY B TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(888) 815-2005
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(888) 815-2005
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
13304
MS
2080P0203X
Pediatric Critical Care Medicine Physician
28959
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
370019646
RR MEDICARE
—
05
—
38418511
—
TN
05
—
3841852
—
TN
01
—
4019556
BCBS
—
Enumeration date
09/15/2006
Last updated
07/21/2022
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