Provider Demographics
NPI:1174094643
Name:TAYLOR, RONALD TODD JR
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:TODD
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-0583
Mailing Address - Country:US
Mailing Address - Phone:458-210-8495
Mailing Address - Fax:
Practice Address - Street 1:44 W BROADWAY STE 225
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3071
Practice Address - Country:US
Practice Address - Phone:458-210-8495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty