Provider Demographics
NPI:1376585596
Name:TAYLOR, LORI KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:KEITH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 BELLEAIR DR NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-2437
Mailing Address - Country:US
Mailing Address - Phone:727-423-7774
Mailing Address - Fax:727-896-1682
Practice Address - Street 1:332 BELLEAIR DR NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-2437
Practice Address - Country:US
Practice Address - Phone:727-423-7774
Practice Address - Fax:727-896-1682
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME824882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5839ZMedicare ID - Type Unspecified
F44526Medicare UPIN