Provider Demographics
NPI:1912971292
Name:TEEKELL TAYLOR, LEAH (MD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:TEEKELL TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W PLATT ST
Mailing Address - Street 2:SUITE 24
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2292
Mailing Address - Country:US
Mailing Address - Phone:727-498-8898
Mailing Address - Fax:727-800-6959
Practice Address - Street 1:10033 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:SUITE 300
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-3830
Practice Address - Country:US
Practice Address - Phone:727-498-8898
Practice Address - Fax:727-800-6959
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94635208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6871YOtherMEDICARE
FL2521753OtherUNITED
273178198OtherHUMANA
FL301311OtherAVMED
FL30977OtherBCBS
FL358811OtherWELLCARE
FL0625432OtherCIGNA
FL4277780OtherAETNA
FL274300100Medicaid
FL358811OtherSTAYWELL
FL0625432OtherCIGNA
FLP00291623Medicare PIN