Provider Demographics
NPI:1578575387
Name:TAYLOR, MARTIN ROBERT (MD,PA)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:ROBERT
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8501 SW 124TH AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4627
Mailing Address - Country:US
Mailing Address - Phone:305-387-0300
Mailing Address - Fax:786-558-7046
Practice Address - Street 1:8501 SW 124TH AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4627
Practice Address - Country:US
Practice Address - Phone:305-387-0300
Practice Address - Fax:786-558-7046
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME11357207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD59419Medicare UPIN