Healthcare Provider Details

I. General information

NPI: 1124344999
Provider Name (Legal Business Name): DAVID BEAUFAIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 US ROUTE 4
ENFIELD NH
03748-3168
US

IV. Provider business mailing address

411 US ROUTE 4 PO BOX 669
ENFIELD NH
03748-3168
US

V. Phone/Fax

Practice location:
  • Phone: 603-632-5600
  • Fax: 603-632-5477
Mailing address:
  • Phone: 603-632-5600
  • Fax: 603-632-5477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6754
License Number StateNH

VIII. Authorized Official

Name: DAVID W BEAUFAIT
Title or Position: OWNER
Credential: M.D.
Phone: 603-632-5600