MEDICARE: DR. MICHAEL E TAVERNARIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician	ME116308	FL
2	207QS0010X	Sports Medicine (Family Medicine) Physician	MD31989	AL
3	207Q00000X	Family Medicine Physician	ME116308	FL
4	207Q00000X	Family Medicine Physician	MD31989	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386888626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL E TAVERNARIS M.D.

Provider Business Mailing Address
First Line	:	208 MARY ESTHER BLVD
Second Line	:
City	:	MARY ESTHER
State	:	FL
Zip	:	32569-1687
Country	:	US
Telephone Number	:	850-396-1110
Fax Number	:	850-466-0950

Provider Business Practice Location Address
First Line	:	1817 LEWIS TURNER BLVD STE F
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1349
Country	:	US
Telephone Number	:	850-396-1110
Fax Number	:	850-466-0950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2009
Last Update Date	:	09/27/2024

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Directions to “ DR. MICHAEL E TAVERNARIS M.D.” Practice Location

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