MEDICARE: PALM HARBOR PLASTIC SURGERY CENTER

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	261QA1903X	Ambulatory Surgical Clinic/Center		FL

General Provider Information

NPI Number	:	1770776296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM HARBOR PLASTIC SURGERY CENTER

Provider Business Mailing Address
First Line	:	35080 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1925
Country	:	US
Telephone Number	:	727-789-5711
Fax Number	:

Provider Business Practice Location Address
First Line	:	35080 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1925
Country	:	US
Telephone Number	:	727-789-5711
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EREL LAUFER
Credential	:	MD
Telephone Number	:	727-789-5711

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	08/20/2007

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