Provider Demographics
NPI:1275501678
Name:THOMAS M. TAYLOR, MD PA
Entity Type:Organization
Organization Name:THOMAS M. TAYLOR, MD PA
Other - Org Name:SKIN HEALTH FOREVER DERMATOLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-440-2462
Mailing Address - Street 1:PO BOX 4769
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33677-4769
Mailing Address - Country:US
Mailing Address - Phone:813-440-2462
Mailing Address - Fax:813-877-6556
Practice Address - Street 1:3214 W TAMPA BAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6616
Practice Address - Country:US
Practice Address - Phone:813-440-2462
Practice Address - Fax:813-877-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064670174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377023100Medicaid
FL23575Medicare ID - Type Unspecified
FL377023100Medicaid