Provider Demographics
NPI:1760485858
Name:KAUFMAN, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 DANNY THOMAS PL # MS 515
Mailing Address - Street 2:ST. JUDE CHILDREN'S RESEARCH HOSPITAL
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-3006
Mailing Address - Fax:901-595-3842
Practice Address - Street 1:262 DANNY THOMAS PL # MS 515
Practice Address - Street 2:262 DANNY THOMAS PLACE
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-3006
Practice Address - Fax:901-595-3842
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN188542085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3497469Medicaid
MS00123048Medicaid
NE100249677-00Medicaid
ME422400000Medicaid
NJ0030741Medicaid
IN100007760AMedicaid
AR114954001Medicaid
LA1687791Medicaid
KS200362220AMedicaid
IA0566240Medicaid
MO202882213Medicaid
NC7614322Medicaid
AL009926165Medicaid
MI104677778Medicaid
GA131025074AMedicaid
KY64792625Medicaid
MS00123048Medicaid
TNC02906Medicare UPIN
MO202882213Medicaid