Provider Demographics
NPI:1710007091
Name:KAUFMAN, HEATHER DAWN (DPM)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:DAWN
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E DIMOND BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2029
Mailing Address - Country:US
Mailing Address - Phone:907-344-2155
Mailing Address - Fax:907-344-8841
Practice Address - Street 1:1000 E DIMOND BLVD STE 201
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2029
Practice Address - Country:US
Practice Address - Phone:907-344-2155
Practice Address - Fax:907-344-8841
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO668213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1710007091OtherNPI
CO1720207863OtherNPIGROUP
CO1710007091OtherRAILROAD MEDICARE
CO66252245Medicaid
CO1720207863OtherNPIGROUP
CO1152560002Medicare NSC