Healthcare Provider Details

I. General information

NPI: 1538310214
Provider Name (Legal Business Name): DAVID T BRAUN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 PARK BLVD N
PINELLAS PARK FL
33781-3534
US

IV. Provider business mailing address

1745 OYSTER POINT WAY
PALM HARBOR FL
34683-3431
US

V. Phone/Fax

Practice location:
  • Phone: 727-347-1286
  • Fax: 727-345-3084
Mailing address:
  • Phone: 727-209-6677
  • Fax: 727-345-3084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number35.099835
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME117110
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD438698
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: