Healthcare Provider Details

I. General information

NPI: 1295792596
Provider Name (Legal Business Name): ERNESTO A KUFOY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ERNESTO A KUFOY M.D

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S PINE ST
DERIDDER LA
70634-4837
US

IV. Provider business mailing address

311 S PINE ST
DERIDDER LA
70634-4837
US

V. Phone/Fax

Practice location:
  • Phone: 337-463-3500
  • Fax: 337-463-3526
Mailing address:
  • Phone: 337-463-3500
  • Fax: 337-463-3526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number11431R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: