Provider Demographics
NPI:1982661484
Name:TAYLOR, GARRY L (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:L
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 1:1658 ST. VINCENT'S WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8431
Mailing Address - Country:US
Mailing Address - Phone:904-276-5100
Mailing Address - Fax:904-276-5393
Practice Address - Street 1:1658 ST. VINCENT'S WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8431
Practice Address - Country:US
Practice Address - Phone:904-276-5100
Practice Address - Fax:904-276-5393
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48911174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044286100Medicaid
FL02166WMedicare ID - Type Unspecified
D50374Medicare UPIN