1164482725 NPI number — DAVID A KAUFMAN M.D.

Table of content: DAVID A KAUFMAN M.D. (NPI 1164482725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164482725 NPI number — DAVID A KAUFMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAUFMAN
Provider First Name:
DAVID
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164482725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1541 KINGS HWY
Provider Second Line Business Mailing Address:
ATTN: PAYOR CREDENTIALING
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71103-4228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-626-0287
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
463 ASHLEY RIDGE BLVD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71106-7231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-221-3584
Provider Business Practice Location Address Fax Number:
318-227-9094
Provider Enumeration Date:
03/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  MD14915 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: MD14915 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 272630100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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