Healthcare Provider Details

I. General information

NPI: 1457770570
Provider Name (Legal Business Name): LAURA ANNE TAYLOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N FLAGLER DR STE 4600
WEST PALM BEACH FL
33401-3408
US

IV. Provider business mailing address

11016 LEGACY DR APT 101
PALM BEACH GARDENS FL
33410-3635
US

V. Phone/Fax

Practice location:
  • Phone: 561-942-7207
  • Fax:
Mailing address:
  • Phone: 203-980-7128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME162139
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number162139
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number162139
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number162139
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: