Provider Demographics
NPI:1851506430
Name:DONOVAN D TAYLOR MD PA
Entity Type:Organization
Organization Name:DONOVAN D TAYLOR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONOVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-655-0702
Mailing Address - Street 1:250 NW 183RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4462
Mailing Address - Country:US
Mailing Address - Phone:305-655-0702
Mailing Address - Fax:305-655-0845
Practice Address - Street 1:250 NW 183RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4462
Practice Address - Country:US
Practice Address - Phone:305-655-0702
Practice Address - Fax:305-655-0845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG32474Medicare UPIN
FLAD572Medicare PIN