Healthcare Provider Details

I. General information

NPI: 1912971292
Provider Name (Legal Business Name): LEAH TEEKELL TAYLOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10033 DR MARTIN LUTHER KING JR ST N SUITE 300
ST PETERSBURG FL
33716-3830
US

IV. Provider business mailing address

301 W PLATT ST SUITE 24
TAMPA FL
33606-2292
US

V. Phone/Fax

Practice location:
  • Phone: 727-498-8898
  • Fax: 727-800-6959
Mailing address:
  • Phone: 727-498-8898
  • Fax: 727-800-6959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME94635
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: