Provider Demographics
NPI:1578635348
Name:KAUFMAN, IRA L (DPM)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:L
Last Name:KAUFMAN
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 1:1047 S BARDEAUX AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:928-726-7772
Mailing Address - Fax:928-726-7742
Practice Address - Street 1:1150 W 24TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-726-7772
Practice Address - Fax:928-726-7742
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0402213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ330118Medicaid
P00084758OtherRAILROAD
AZ0195100OtherBLUE CROSS BLUE SHIELD
AZ0195100OtherBLUE CROSS BLUE SHIELD
AZ330118Medicaid