Provider Demographics
NPI:1841290947
Name:KAUFMAN, CARY S (MD)
Entity type:Individual
Prefix:
First Name:CARY
Middle Name:S
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 1:2075 BARKLEY BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6614
Mailing Address - Country:US
Mailing Address - Phone:360-671-9877
Mailing Address - Fax:360-733-2882
Practice Address - Street 1:2075 BARKLEY BLVD STE 250
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6614
Practice Address - Country:US
Practice Address - Phone:360-671-9877
Practice Address - Fax:360-733-2882
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014269208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50394OtherDEPT OF LABOR INDUSTRIES
WA8923151OtherCRIME VICTIMS
WA1087766Medicaid
A44325Medicare UPIN
WA50394OtherDEPT OF LABOR INDUSTRIES