Provider Demographics
NPI:1700866621
Name:TAYLOR, THOMAS BRITT (M D)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:BRITT
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:M D
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 45443
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84145-0443
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:463832 STATE ROAD 200
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-3638
Practice Address - Country:US
Practice Address - Phone:904-225-2311
Practice Address - Fax:904-225-8481
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15223 R207Q00000X
FLME95347207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00364113OtherRAILROAD MEDICARE
FLI01820Medicare PIN
FLP00364113OtherRAILROAD MEDICARE
LA55685Medicaid
FLI01820Medicare PIN