Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | D33428 | MD |
Y | 207N00000X | Dermatologist | ME112983 | FL |
N | 207ND0900X | Dermatopathologist | D33428 | MD |
N | 207ND0900X | Dermatopathologist | ME112983 | FL |
NPI | 1720189657 |
---|---|
Provider Name | Dr. Robert Michael Taylor |
First Address | Palm Bay, FL 32907-1157 |
Second Address | Palm Bay, FL 32907-1157 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 07/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
406731200 | (05) | MD |
D75023 | (02) | MD |
GP501Y | MEDICARE PTAN (01) | FL |