Healthcare Provider Details

I. General information

NPI: 1346804903
Provider Name (Legal Business Name): JEREMY TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1616 NW 7TH PL
GAINESVILLE FL
32603-1210
US

V. Phone/Fax

Practice location:
  • Phone: 772-403-3545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberME168956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: