Provider Demographics
NPI:1528037611
Name:TAYLOR, CHARLES DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAVID
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 1:10904 THERESA ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-3144
Mailing Address - Country:US
Mailing Address - Phone:813-695-4121
Mailing Address - Fax:813-988-4760
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:ACC (11C)
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-695-4121
Practice Address - Fax:813-910-4042
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine