Individual
HUBERT D TAYLOR II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
960 AVENT DR, GRENADA, MS 38901-5230
(662) 227-7000
Mailing address
960 AVENT DR, GRENADA, MS 38901-5230
(662) 227-7000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
21117
MS
207P00000X
Emergency Medicine Physician
34-009791
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08305840
—
MS
01
—
P01560408
RAILROAD MEDICARE
MS
Enumeration date
04/06/2010
Last updated
10/31/2016
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