Taiwan lies between two tectonic plates in the "Pacific Ring of Fire" and is regularly hit by earthquakes.
Dozens of people are believed to be trapped in a residential block in the city of Tainan, according to local reports.
Firefighters said 123 people have been rescued so far from the 17-storey building.
"There are 60 households in that building," said Tainan City Government Fire Bureau spokesman Lee Po Min.
He estimated there might be about 240 people living there.
Formosa TV said 37 people were rescued from another seven-storey property. Reports said the building is a bank.
Its reporters said they could hear cries of help from inside one destroyed building. Officials said four buildings have collapsed in the two million-population city, and there are no immediate reports of casualties.
The US Geological Survey said the quake struck at a depth of six miles (10km), about 27 miles (43km) southeast of Tainan.
Tremors were felt in the capital Taipei, on the other side of the island.
The quake was initially reported as having a magnitude of 6.7, but was later downgraded to 6.4.
At least five aftershocks of 3.8 magnitude or more shook Tainan 30 minutes after the initial quake, Taiwan's Central Weather Bureau said.
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