Physician Compare National (NPI:1275952780)

HEALTHCARE PROVIDER: TAYLOR LLOYD DODGEN

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1275952780
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8022231570
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190118000547
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DODGEN
	Individual professional last name
Provider First Name	TAYLOR
	Individual professional first name
Provider Middle Name	LLOYD
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	INDIANA UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	DERMATOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	INTERCOASTAL MEDICAL GROUP INC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	6305730912
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	138
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	11715 RANGELAND PKWY
	Group Practice or individual's line 1 address
City	BRADENTON
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	342119529
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9415380001
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y