MEDICARE: BRYAN LEE KAUFMAN 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	2085R0202X	Diagnostic Radiology Physician	ME74867	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	300110020	OTHER	RR
2	43420	OTHER	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881691764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN LEE KAUFMAN M.D.

Provider Business Mailing Address
First Line	:	4136 STOWE RUN LN
Second Line	:	STE 204
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-1622
Country	:	US
Telephone Number	:	216-255-5743
Fax Number	:	866-735-3451

Provider Business Practice Location Address
First Line	:	4136 STOWE RUN LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-1622
Country	:	US
Telephone Number	:	828-389-9740
Fax Number	:	866-735-3451

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	02/13/2017

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