Provider Demographics
NPI:1326023920
Name:TAYLOR, MICHAEL WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WAYNE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2202 STATE AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7601
Mailing Address - Country:US
Mailing Address - Phone:850-784-1856
Mailing Address - Fax:850-784-1975
Practice Address - Street 1:2202 STATE AVE
Practice Address - Street 2:STE. 207
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7601
Practice Address - Country:US
Practice Address - Phone:850-784-1856
Practice Address - Fax:850-784-1975
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2022-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME87887208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272292500Medicaid
FL272292500Medicaid
FL272292500Medicaid