Individual
RUSSELL J TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
770 WEST HIGH STREET, SUITE 350, LIMA, OH 45801-5901
(419) 228-8950
(419) 224-7904
Mailing address
PO BOX 636930, CINCINNATI, OH 45263-0001
(513) 981-5123
(513) 981-5015
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
35045028
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000596289
ANTHEM PIN
OH
05
—
0437932
—
OH
01
—
06151
PARAMOUNT ADVANTAGE MEDICAID
OH
01
—
262788491032
CARESOURCE MEDICAID
OH
01
—
3358254
CIGNA
OH
01
—
4218612
AETNA
OH
01
—
735041
BUCKEYE MEDICAID
OH
Enumeration date
12/19/2005
Last updated
08/15/2013
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