Healthcare Provider Details

I. General information

NPI: 1831142090
Provider Name (Legal Business Name): DR. HENRY J KAUFMAN IV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 COOLIDGE BLVD
LAFAYETTE LA
70503-2433
US

IV. Provider business mailing address

120 RUE LOUIS XIV
LAFAYETTE LA
70508-5739
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-5774
  • Fax: 337-237-4939
Mailing address:
  • Phone: 337-769-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number200089
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number200089
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: