Provider Demographics
NPI:1891880555
Name:KAUFFMAN, PAUL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AR
Mailing Address - Zip Code:72576-0189
Mailing Address - Country:US
Mailing Address - Phone:870-895-2541
Mailing Address - Fax:
Practice Address - Street 1:507 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:AR
Practice Address - Zip Code:72576-9449
Practice Address - Country:US
Practice Address - Phone:870-895-2541
Practice Address - Fax:870-895-2957
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102739001Medicaid
ARB90318Medicare UPIN