Provider Demographics
NPI:1538283684
Name:KAUFMAN, JEROME EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:EDWARD
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16521 TURQUOISE TRL
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3180
Mailing Address - Country:US
Mailing Address - Phone:954-385-0989
Mailing Address - Fax:954-349-0457
Practice Address - Street 1:1730 MAIN ST
Practice Address - Street 2:SUITE 212
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3675
Practice Address - Country:US
Practice Address - Phone:954-385-0989
Practice Address - Fax:954-349-0457
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 881202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C10097Medicare UPIN