Provider Demographics
NPI:1407859390
Name:KAUFMAN, JOEL MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:MARK
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 1:11960 LIONESS WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-0000
Mailing Address - Country:US
Mailing Address - Phone:303-695-8706
Mailing Address - Fax:303-695-1211
Practice Address - Street 1:11960 LIONESS WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-0000
Practice Address - Country:US
Practice Address - Phone:303-695-8706
Practice Address - Fax:303-695-1211
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19531174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD23625Medicare UPIN