| Taylen Peaden D.o. Pllc | |
|
1111 Sw Main Blvd Lake City FL 32025-5767 | |
| (386) 365-4922 | |
| Not Available |
| Full Name | Taylen Peaden D.o. Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1111 Sw Main Blvd, Lake City, Florida |
| Authorized Official Name and Position | Taylen Clay Peaden (OWNER) |
| Authorized Official Contact | 3863654922 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Taylen Peaden D.o. Pllc 1111 Sw Main Blvd Lake City FL 32025-5767 Ph: () - | Taylen Peaden D.o. Pllc 1111 Sw Main Blvd Lake City FL 32025-5767 Ph: (386) 365-4922 |
| NPI Number | 1710693858 |
|---|---|
| Provider Enumeration Date | 01/23/2023 |
| Last Update Date | 01/23/2023 |
| Medicare PECOS PAC ID | 9133587793 |
|---|---|
| Medicare Enrollment ID | O20230614002326 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710693858 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Taylen C Peaden |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669505111 PECOS PAC ID: 9931124765 Enrollment ID: I20230614002746 |
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