Provider Demographics
NPI:1134233968
Name:TAYLOR, KEVIN THOMAS (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:THOMAS
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 1:3801 N HIGHWAY 19A
Mailing Address - Street 2:SUITE # 402
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2228
Mailing Address - Country:US
Mailing Address - Phone:352-383-4600
Mailing Address - Fax:
Practice Address - Street 1:3801 N HIGHWAY 19A
Practice Address - Street 2:SUITE # 402
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2228
Practice Address - Country:US
Practice Address - Phone:352-383-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49634207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037817800Medicaid
FLE21545Medicare UPIN
FL07618Medicare ID - Type Unspecified