MEDICARE: KEVIN M MCAULIFFE MD PA

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	:	1104094853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN M MCAULIFFE MD PA

Provider Business Mailing 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	:	904-268-7375

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	:	904-268-7375

Authorized Official
Title or Position	:	OWNER
Name	:	KEVIN M MCAULIFFE
Credential	:	MD PA
Telephone Number	:	904-268-7400

Provider Enumeration Date	:	02/15/2008
Last Update Date	:	03/03/2008

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