Provider Demographics
NPI:1699230102
Name:KOFFMAN, ALLYSON ENID (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:ENID
Last Name:KOFFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 GLADES RD # 4A
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6401
Mailing Address - Country:US
Mailing Address - Phone:561-391-8066
Mailing Address - Fax:
Practice Address - Street 1:4256 BATHURST ST
Practice Address - Street 2:100
Practice Address - City:TORONTO
Practice Address - State:ONTARIO
Practice Address - Zip Code:M3H5Y8
Practice Address - Country:CA
Practice Address - Phone:647-352-7188
Practice Address - Fax:647-352-7190
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA813378207Q00000X
CAC162016207Q00000X
FLME153528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine