| Entity Name: | DAVID BRAUN MD PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Aug 2015 (9 years ago) |
| Document Number: | L15000133933 |
| FEI/EIN Number | 47-4754011 |
| Address: | 4820 Park Blvd N, Suite 1, Pinellas Park, FL, 33781, US |
| Mail Address: | 1745 OYSTER POINT WAY, Palm Harbor, FL, 34683, US |
| ZIP code: | 33781 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205357092 | 2017-06-30 | 2020-09-23 | 1745 OYSTER POINT WAY, PALM HARBOR, FL, 346833431, US | 4820 PARK BLVD N, PINELLAS PARK, FL, 337813534, US | |||||||||||||||||||||||||||||
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| Phone | +1 727-209-6677 |
| Fax | 7278737408 |
Authorized person
| Name | DR. DAVID TIMOTHY BRAUN |
| Role | OWNER |
| Phone | 7272096677 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 207XX0004X - Orthopaedic Foot and Ankle Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 207XX0005X - Sports Medicine (Orthopaedic Surgery) Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 012959000 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID BRAUN MD PLLC 401(K) PROFIT SHARING PLAN & TRUST | 2019 | 474754011 | 2020-07-14 | DAVID BRAUN MD PLLC | 7 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2020-07-14 |
| Name of individual signing | EDWARD ROJAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| BRAUN DAVID T | Agent | 1745 OYSTER POINT WAY, Palm Harbor, FL, 34683 |
| Name | Role | Address |
|---|---|---|
| BRAUN DAVID T | President | 1745 OYSTER POINT WAY, Palm Harbor, FL, 34683 |
| Name | Role | Address |
|---|---|---|
| Braun Caitlin | Vice President | 1745 OYSTER POINT WAY, Palm Harbor, FL, 34683 |
| Name | Role | Address |
|---|---|---|
| Perez-Mustelier Julio D | Authorized Member | 4820 Park Blvd N, Pinellas Park, FL, 33781 |
| Warren Steven | Authorized Member | 4820 Park Blvd N, Pinellas Park, FL, 33781 |
| Ragsdell Matthew | Authorized Member | 4820 Park Blvd N, Pinellas Park, FL, 33781 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000002191 | BAY AREA ORTHOPAEDIC SPECIALISTS | ACTIVE | 2018-01-03 | 2028-12-31 | No data | 1745 OYSTER POINT WAY, PALM HARBOR, FL, 34683 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2019-04-10 | 4820 Park Blvd N, Suite 1, Pinellas Park, FL 33781 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-10 | 1745 OYSTER POINT WAY, Palm Harbor, FL 34683 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-03 | 4820 Park Blvd N, Suite 1, Pinellas Park, FL 33781 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-27 |
| ANNUAL REPORT | 2023-03-15 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-04-07 |
| ANNUAL REPORT | 2020-01-24 |
| ANNUAL REPORT | 2019-04-10 |
| AMENDED ANNUAL REPORT | 2018-04-03 |
| ANNUAL REPORT | 2018-03-03 |
| ANNUAL REPORT | 2017-04-07 |
| ANNUAL REPORT | 2016-09-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
