MEDICARE: TAYLOR ALEXANDER O'BRIEN

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	207Q00000X	Family Medicine Physician	111553	GA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207Q00000X	Family Medicine Physician	ME176052	FL

General Provider Information

NPI Number	:	1689376865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR ALEXANDER O'BRIEN

Provider Business Mailing Address
First Line	:	6500 38TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-1629
Country	:	US
Telephone Number	:	727-384-7727
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 38TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-1629
Country	:	US
Telephone Number	:	727-384-7727
Fax Number	:

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

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	03/13/2026

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