Provider Demographics
NPI:1407914013
Name:KAUFFMAN, GARY (PA)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:KAUFFMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 713
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:NC
Mailing Address - Zip Code:28901-0713
Mailing Address - Country:US
Mailing Address - Phone:828-837-2521
Mailing Address - Fax:828-837-5844
Practice Address - Street 1:36 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-2949
Practice Address - Country:US
Practice Address - Phone:828-837-2521
Practice Address - Fax:828-837-5844
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100687363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP77559Medicare UPIN
NC2799133BMedicare ID - Type Unspecified