Healthcare Provider Details

I. General information

NPI: 1619973641
Provider Name (Legal Business Name): WAYNE R TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 09/03/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 MEDICAL DR
HUDSON FL
34667-6502
US

IV. Provider business mailing address

PO BOX 23643
TAMPA FL
33623-3643
US

V. Phone/Fax

Practice location:
  • Phone: 727-869-5551
  • Fax: 727-868-6488
Mailing address:
  • Phone: 727-869-5551
  • Fax: 727-868-6488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0049872
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberME49872
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: