Provider Demographics
NPI:1407993538
Name:KAUFFMAN, STEPHEN J (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:KAUFFMAN
Suffix:
Gender:M
Credentials:DPM
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 1990
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34423-1990
Mailing Address - Country:US
Mailing Address - Phone:352-746-2663
Mailing Address - Fax:352-746-6907
Practice Address - Street 1:950 N AVALON WAY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-6004
Practice Address - Country:US
Practice Address - Phone:352-746-2663
Practice Address - Fax:352-746-6907
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002716213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340666100Medicaid
FL65566YMedicare ID - Type Unspecified
FL340666100Medicaid