Provider Demographics
NPI:1356357883
Name:KAUFFMAN, ALAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:KAUFFMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BUTTERMILK RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-6432
Mailing Address - Country:US
Mailing Address - Phone:501-228-0747
Mailing Address - Fax:501-228-0304
Practice Address - Street 1:16 BUTTERMILK RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-6432
Practice Address - Country:US
Practice Address - Phone:501-228-0747
Practice Address - Fax:501-228-0304
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR87-21P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59394Medicare ID - Type UnspecifiedMEDICARE