Provider Demographics
NPI:1407992662
Name:TAYLOR, LEIGHTON ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:LEIGHTON
Middle Name:ANDREW
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 1:293 NW PEACOCK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2222
Mailing Address - Country:US
Mailing Address - Phone:772-204-8870
Mailing Address - Fax:772-204-8873
Practice Address - Street 1:2402 FRIST BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4838
Practice Address - Country:US
Practice Address - Phone:772-462-3939
Practice Address - Fax:772-462-3938
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71688208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253182800Medicaid
FL38049AMedicare ID - Type Unspecified
FL253182800Medicaid