Provider Demographics
NPI:1053350207
Name:KAUFFMAN, JAMIE MARIE (DO)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MARIE
Other - Last Name:HAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1205 N MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-2095
Mailing Address - Country:US
Mailing Address - Phone:660-385-8700
Mailing Address - Fax:660-385-8701
Practice Address - Street 1:1201 N RUTHERFORD ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-2020
Practice Address - Country:US
Practice Address - Phone:660-385-8900
Practice Address - Fax:660-385-8708
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO2002014388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209151208Medicaid
MOH71908Medicare UPIN
MO9085039201Medicare ID - Type Unspecified