Provider Demographics
NPI:1538156302
Name:KAUFMAN, DAVID GEORGE JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GEORGE JOHN
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 N 139TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-6057
Mailing Address - Country:US
Mailing Address - Phone:402-955-3000
Mailing Address - Fax:402-955-7055
Practice Address - Street 1:13808 W MAPLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-6231
Practice Address - Country:US
Practice Address - Phone:402-955-3000
Practice Address - Fax:402-955-7055
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21095208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEH10096Medicare UPIN