MEDICARE: MR. DAVID T KAUFMANN CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN356004L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	071065	OTHER	PA	AANA NO.

General Provider Information

NPI Number	:	1437115938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID T KAUFMANN CRNA

Provider Business Mailing Address
First Line	:	2572 PEAKE ST
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-6006
Country	:	US
Telephone Number	:	724-255-1928
Fax Number	:

Provider Business Practice Location Address
First Line	:	2572 PEAKE ST
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-6006
Country	:	US
Telephone Number	:	724-255-1928
Fax Number	:

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

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	01/21/2016

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