Provider Demographics
NPI:1366559494
Name:DAVID AUERBACH MD PA
Entity type:Organization
Organization Name:DAVID AUERBACH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:AUERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-331-7688
Mailing Address - Street 1:7003 NW 11TH PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3176
Mailing Address - Country:US
Mailing Address - Phone:352-331-7688
Mailing Address - Fax:352-331-7611
Practice Address - Street 1:7003 NW 11TH PL
Practice Address - Street 2:SUITE 1
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3176
Practice Address - Country:US
Practice Address - Phone:352-331-7688
Practice Address - Fax:352-331-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME23286174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL406292132OtherRRMC
FL036484300Medicaid
FL01245Medicare PIN
FL406292132OtherRRMC