Healthcare Provider Details

I. General information

NPI: 1063580645
Provider Name (Legal Business Name): PAUL W KAUFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 HOSPITAL DR
SANTA FE NM
87505-4743
US

IV. Provider business mailing address

25 LA VIS
SANTA FE NM
87505-9002
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4848
  • Fax:
Mailing address:
  • Phone: 505-988-1987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number71-46
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: