Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | PO3493 | FL |
NPI | 1376836262 |
---|---|
Provider Name | Dr. Mindy Taylor |
First Address | Port Orange, FL 32128-8311 |
Second Address | Port Orange, FL 32128-8311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2011 |
Last Update Date | 21/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006116800 | (05) | FL |
P01085890 | RAILROAD PTAN (01) | FL |