Provider Demographics
NPI:1962542282
Name:TAITT, EARL PAUL JR (MD)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:PAUL
Last Name:TAITT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4151 HUNTERS PARK LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7690
Mailing Address - Country:US
Mailing Address - Phone:407-856-8830
Mailing Address - Fax:407-856-8802
Practice Address - Street 1:4151 HUNTERS PARK LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7690
Practice Address - Country:US
Practice Address - Phone:407-856-8830
Practice Address - Fax:407-856-8802
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME624652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371312100Medicaid
FL18040Medicare ID - Type Unspecified
FLF39241Medicare UPIN