Provider Demographics
NPI:1306023510
Name:SAFFO, KARL SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:SAMUEL
Last Name:SAFFO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KHALID
Other - Middle Name:SAID
Other - Last Name:SAFFO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:609 E PENCE RD
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-8823
Mailing Address - Country:US
Mailing Address - Phone:816-632-1390
Mailing Address - Fax:816-632-5809
Practice Address - Street 1:609 E PENCE RD
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-8823
Practice Address - Country:US
Practice Address - Phone:816-632-1390
Practice Address - Fax:816-632-5809
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5334174400000X
KS04-15405174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C5023-0Medicare UPIN