MEDICARE: KEVIN MCAULIFFE

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	207W00000X	Ophthalmology Physician	0033893	FL

General Provider Information

NPI Number	:	1831196575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN MCAULIFFE

Provider Business Mailing Address
First Line	:	9925 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5851
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9925 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5851
Country	:	US
Telephone Number	:	904-268-7400
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	12/20/2007

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