Provider Demographics
NPI:1144251364
Name:KAUFFMAN, PETER JOSEPH (PAC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JOSEPH
Last Name:KAUFFMAN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8798
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:
Practice Address - Street 1:205 PAGE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8798
Practice Address - Country:US
Practice Address - Phone:910-295-5511
Practice Address - Fax:910-235-3401
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0371PAOtherSC MEDICAID PROVIDER#
NCP00237185OtherPALMETTO GBA PROVIDER#
NCE4010OtherMEDCOST PROVIDER#
NCFH400495OtherFIRSTCAROLINACARE PROV.#
NC2763888Medicare ID - Type Unspecified
NCP00237185OtherPALMETTO GBA PROVIDER#