MEDICARE: ADAM BAUERNFEIND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9111280	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457842189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM BAUERNFEIND

Provider Business Mailing Address
First Line	:	234 HOPKINS ST
Second Line	:
City	:	NEPTUNE BEACH
State	:	FL
Zip	:	32266-4825
Country	:	US
Telephone Number	:	321-501-6137
Fax Number	:

Provider Business Practice Location Address
First Line	:	12700 PARK CENTRAL DR STE 900
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-1542
Country	:	US
Telephone Number	:	321-501-6137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	05/29/2018

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Directions to “ ADAM BAUERNFEIND ” Practice Location

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