Provider Demographics
NPI:1174522437
Name:TAYLOR, DENISE J (MD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 CANYON RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-4001
Mailing Address - Country:US
Mailing Address - Phone:817-274-5885
Mailing Address - Fax:817-276-0015
Practice Address - Street 1:2517 CANYON RIDGE CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-4001
Practice Address - Country:US
Practice Address - Phone:817-274-5885
Practice Address - Fax:817-276-0015
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG25792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138235009Medicaid
D69175Medicare UPIN
TX138235009Medicaid