Provider Demographics
NPI:1497859904
Name:TALIAFERRO, ARTHUR CORTLAND (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:CORTLAND
Last Name:TALIAFERRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15280 NW 79TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5873
Mailing Address - Country:US
Mailing Address - Phone:305-558-3724
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:3 SAN BARTOLA DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5767
Practice Address - Country:US
Practice Address - Phone:904-823-8823
Practice Address - Fax:904-808-8587
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66602207YX0007X
FLME0066602207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040010602OtherRR MEDICARE
FL377005200Medicaid
F93742Medicare UPIN
FL377005200Medicaid