Provider Demographics
NPI:1619973641
Name:TAYLOR, WAYNE R (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:R
Last Name:TAYLOR
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:PO BOX 23643
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33623-3643
Mailing Address - Country:US
Mailing Address - Phone:727-869-5551
Mailing Address - Fax:727-868-6488
Practice Address - Street 1:7525 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6502
Practice Address - Country:US
Practice Address - Phone:727-869-5551
Practice Address - Fax:727-868-6488
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049872207R00000X
FLME498722083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010785400Medicaid
FL05605OtherBCBS FL
FL05605OtherBCBS FL
FL05605SMedicare PIN
FL010785400Medicaid
A66372Medicare UPIN