Provider Demographics
NPI:1568464931
Name:TAYLOR, THOMAS M (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3514 W BAY TO BAY BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7018
Mailing Address - Country:US
Mailing Address - Phone:813-440-2462
Mailing Address - Fax:813-877-6556
Practice Address - Street 1:3514 W BAY TO BAY BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7018
Practice Address - Country:US
Practice Address - Phone:813-440-2462
Practice Address - Fax:813-877-6556
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2020-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0064670174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377023100Medicaid
FLF03450Medicare UPIN
FL377023100Medicaid