Provider Demographics
NPI:1699842062
Name:TOWNSEND, LAYLA R (DO)
Entity Type:Individual
Prefix:
First Name:LAYLA
Middle Name:R
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:DO
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 25317
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5317
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:625 6TH AVENUE SOUTH
Practice Address - Street 2:SUITE #350
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-456-0080
Practice Address - Fax:727-456-0089
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014886207V00000X
FLOS10467207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LT014886OtherCOMMERCIAL-COMMERCIAL NUMBER
MI473433711Medicaid
LT014886OtherCHAMPUS-CHAMPUS
700H262210OtherBLUE CROSS-BLUE CROSS
I32083Medicare UPIN
700H262210OtherBLUE CROSS-BLUE CROSS