Healthcare Provider Details

I. General information

NPI: 1124433552
Provider Name (Legal Business Name): RICHARD TAYLOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NE MIAMI GARDENS DR 202
NORTH MIAMI BEACH FL
33179-4845
US

IV. Provider business mailing address

1400 NE MIAMI GARDENS DR 202
NORTH MIAMI BEACH FL
33179-4845
US

V. Phone/Fax

Practice location:
  • Phone: 305-944-8565
  • Fax: 305-944-8388
Mailing address:
  • Phone: 305-944-8565
  • Fax: 305-944-8388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME0034801
License Number StateFL

VIII. Authorized Official

Name: RICHARD TAYLOR
Title or Position: OWNER
Credential:
Phone: 305-944-8565