Provider Demographics
NPI:1730773870
Name:KAUFMAN, MARK ANTHONY
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7516 BLUEBONNET BLVD # 181
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1627
Mailing Address - Country:US
Mailing Address - Phone:225-907-7048
Mailing Address - Fax:
Practice Address - Street 1:7516 BLUEBONNET BLVD # 181
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1627
Practice Address - Country:US
Practice Address - Phone:225-907-7048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA343800000XOtherTAXONOMY