Provider Demographics
NPI:1548210214
Name:KOFF, NORMAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:
Last Name:KOFF
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 1282
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34973
Mailing Address - Country:US
Mailing Address - Phone:863-763-5280
Mailing Address - Fax:863-763-5280
Practice Address - Street 1:2006 SW 5TH DR
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974
Practice Address - Country:US
Practice Address - Phone:863-763-5280
Practice Address - Fax:863-763-5280
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00435213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041281300Medicaid
T55411Medicare UPIN
FL041281300Medicaid