Provider Demographics
NPI:1497065973
Name:MARK TAYLOR MD AND ASSOCIATES PA
Entity Type:Organization
Organization Name:MARK TAYLOR MD AND ASSOCIATES PA
Other - Org Name:O/O LENDEL M TAYLOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LENDEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-653-1150
Mailing Address - Street 1:P.O. BOX 1150
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-1150
Mailing Address - Country:US
Mailing Address - Phone:813-653-1150
Mailing Address - Fax:813-653-1429
Practice Address - Street 1:1454 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4853
Practice Address - Country:US
Practice Address - Phone:813-653-1150
Practice Address - Fax:813-653-1429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty