MEDICARE: DR. DAVID MULVANEY M.D.

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	207P00000X	Emergency Medicine Physician	ME69129	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578509659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MULVANEY M.D.

Provider Business Mailing Address
First Line	:	861 SW 78TH AVE
Second Line	:	SUITE #100B
City	:	PLANTATION
State	:	FL
Zip	:	33324-3229
Country	:	US
Telephone Number	:	954-693-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	13100 FORT KING RD
Second Line	:	EMERGENCY DEPARTMENT
City	:	DADE CITY
State	:	FL
Zip	:	33525-5294
Country	:	US
Telephone Number	:	352-521-1100
Fax Number	:

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	06/07/2016

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