Provider Demographics
NPI:1578574497
Name:KAUFMAN, SANFORD ALTON (MD)
Entity Type:Individual
Prefix:
First Name:SANFORD
Middle Name:ALTON
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 TURNING LEAF AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8380
Mailing Address - Country:US
Mailing Address - Phone:772-263-8031
Mailing Address - Fax:
Practice Address - Street 1:500 NW DIXIE HWY SUITE 102
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-263-8031
Practice Address - Fax:772-781-6444
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME16083208D00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
090395OtherVALUE OPTIONS
FLN222062OtherHEALTH EASE WELLCARE
FL1509674OtherUNITED HEALTH CARE
B97338Medicare UPIN
FL1509674OtherUNITED HEALTH CARE