Healthcare Provider Details

I. General information

NPI: 1083820120
Provider Name (Legal Business Name): DR. WILL KAUFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 RIO BRAVO BLVD SW STE 36
ALBUQUERQUE NM
87105-6060
US

IV. Provider business mailing address

PO BOX 740018
ATLANTA GA
30374-0018
US

V. Phone/Fax

Practice location:
  • Phone: 505-777-3004
  • Fax: 505-808-4990
Mailing address:
  • Phone: 505-777-3004
  • Fax: 505-808-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number239066
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD 2012-0859
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: