Provider Demographics
NPI:1407964208
Name:KAUFMAN, JOAN ARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:ARLENE
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOAN
Other - Middle Name:ARLENE
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5 WINDWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-668-2987
Mailing Address - Fax:
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:VA HOSP, RADIATION ONCOLOGY DEPT.
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-577-7285
Practice Address - Fax:901-577-7428
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000271152085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C-685-72Medicare UPIN