=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639569890
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. MICHAEL ALAN LAYTON MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2015
-----------------------------------------------------
Last Update Date | 01/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7744 BAY ST UNIT 2
-----------------------------------------------------
City | SEBASTIAN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32958-3427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-388-8322
-----------------------------------------------------
Fax | 772-388-8323
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7744 BAY ST UNIT 2
-----------------------------------------------------
City | SEBASTIAN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32958-3427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-388-8322
-----------------------------------------------------
Fax | 772-388-8323
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. MICHAEL A LAYTON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 772-388-8322
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | ME82848
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------