Roosevelt Taylor Jr. (NPI# 1659449288, PAC ID# 4486780798) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is OBSTETRICS/GYNECOLOGY.
| Nation Provider ID (NPI) | 1659449288 |
| PAC ID by PECOS | 4486780798 |
| Professional Enrollment ID | I20100325000848 |
| Full Name | Roosevelt Taylor Jr. |
| Organization Legal Name | FULL LIFE OUTREACH MEDICAL CENTER LLC |
| Address |
1000 Sapphire St Longview TX 75602-3652 |
| Phone Number | 2147912863 |
| Gender | M |
| Medical School | HOWARD UNIVERSITY COLLEGE OF MEDICINE |
| Graduation Year | 1964 |
| Primary Specialty | OBSTETRICS/GYNECOLOGY |
| Group Practice PAC ID | 2062676968 |
| Number of Group Practice Members | 4 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 1000 Sapphire St, Longview, TX 75602-3652 | 2147912863 | FULL LIFE OUTREACH MEDICAL CENTER LLC |
| Organization Legal Name | FULL LIFE OUTREACH MEDICAL CENTER LLC |
| Physicians | 2 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Iris W Banks | Clinical Social Worker | Full Life Outreach Medical Center LLC | 4545 S Buckner Blvd, Dallas, TX 75227-4207 |
| Street Address |
1000 SAPPHIRE ST |
| City | LONGVIEW |
| State | TX |
| Zip | 75602-3652 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kari L Kennel | Nurse Practitioner | East Texas Border Health Clinic | 2131 S Mobberly Ave, Longview, TX 75602-3563 |
| Julia Ann Russell | Nurse Practitioner | East Texas Border Health Clinic | 2131 S Mobberly Ave, Longview, TX 75602-3563 |
| City | LONGVIEW |
| Zip Code | 75602 |
| Specialty | OBSTETRICS/GYNECOLOGY |
| City + Specialty | LONGVIEW + OBSTETRICS/GYNECOLOGY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.