Provider Demographics
NPI:1083867295
Name:MARIA U TEDTAOTAO MD PA
Entity Type:Organization
Organization Name:MARIA U TEDTAOTAO MD PA
Other - Org Name:ZOE FAMILY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-271-5996
Mailing Address - Street 1:1303 MOSLEY DR
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5625
Mailing Address - Country:US
Mailing Address - Phone:850-271-5996
Mailing Address - Fax:850-271-4088
Practice Address - Street 1:1303 MOSLEY DR
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-5625
Practice Address - Country:US
Practice Address - Phone:850-271-5996
Practice Address - Fax:850-271-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
FLME72254261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty