Provider Demographics
NPI:1629006309
Name:KAUFFMAN, ROGER J (MD)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:J
Last Name:KAUFFMAN
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 1:208 W COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-1434
Mailing Address - Country:US
Mailing Address - Phone:937-404-2488
Mailing Address - Fax:937-404-2428
Practice Address - Street 1:208 W COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1434
Practice Address - Country:US
Practice Address - Phone:937-404-2488
Practice Address - Fax:937-404-2428
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0424713Medicaid
OHKA0476012Medicare ID - Type Unspecified
OH0424713Medicaid