Organization
DR. ROOSEVELT TAYLOR JR PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROOSEVELT TAYLOR JR. M.D. (PHYICIAN PRESIDENT)
(214) 391-3700
Entity
Organization
Contact information
Practice address
9209 ELAM RD STE 100, DALLAS, TX 75217-7360
(214) 391-3700
Mailing address
9209 ELAM RD STE 100, DALLAS, TX 75217-7360
(214) 391-3700
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
D9896
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10029783
MEDICAID AMERIGOUP HMO
TX
05
—
121397702
—
TX
Enumeration date
02/18/2010
Last updated
02/18/2010
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