Provider Demographics
NPI:1164482725
Name:KAUFMAN, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 ASHLEY RIDGE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7231
Mailing Address - Country:US
Mailing Address - Phone:318-221-3584
Mailing Address - Fax:318-227-9094
Practice Address - Street 1:463 ASHLEY RIDGE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7231
Practice Address - Country:US
Practice Address - Phone:318-221-3584
Practice Address - Fax:318-227-9094
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0092763207KA0200X
LAMD14915207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272630100Medicaid
FL16104ZMedicare ID - Type Unspecified
FL272630100Medicaid