Provider Demographics
NPI:1275952780
Name:DODGEN, TAYLOR LLOYD
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LLOYD
Last Name:DODGEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11715 RANGELAND PKWY
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9529
Mailing Address - Country:US
Mailing Address - Phone:941-538-0022
Mailing Address - Fax:941-538-0023
Practice Address - Street 1:11715 RANGELAND PKWY
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-9529
Practice Address - Country:US
Practice Address - Phone:941-538-0022
Practice Address - Fax:941-538-0023
Is Sole Proprietor?:No
Enumeration Date:2014-04-11
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137069207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology