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General NPI Number Information
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NPI Number | 1407992662
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Entity Type | Individual
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Provider Name | LEIGHTON ANDREW TAYLOR M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 2402 FRIST BLVD SUITE 204
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City | FORT PIERCE
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State | FL
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Zip | 34950-4838
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Country | US
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Telephone | 772-462-3939
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Fax | 772-462-3938
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Provider Business Mailing Address
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Address Line | 293 NW PEACOCK BLVD STE 201
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-2222
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Country | US
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Telephone | 772-204-8870
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Fax | 772-204-8873
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME71688
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | ME71688
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License Number State | FL
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