Active NPI
Edward Charles Kauffman, MD
- MOHS-Micrographic Surgery Physician
- Flagstaff, AZ
National Provider Identifier
1790799450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- MOHS-Micrographic Surgery Physician
- License
- 33121
- Practice address
- 1490 N Turquoise Dr
Flagstaff, AZ 86001 - Phone
- (928) 774-5074
- Fax
- (928) 779-0884
- NPI assigned
- Jul 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 33121 | AZ | |
| MOHS-Micrographic Surgery Physician | 207ND0101X | 33121 | AZ | Primary |
| Procedural Dermatology Physician | 207NS0135X | 33121 | AZ |
Addresses
Primary practice location
1490 N Turquoise Dr
Flagstaff, AZ 86001
Mailing address
1490 N Turquoise Dr
Flagstaff, AZ 86001
Phone (928) 774-5074
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89184N | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33121 | AZ | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1790799450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1490 N TURQUOISE DR",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "86001",
"telephone_number": "928-774-5074",
"fax_number": "928-779-0884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1490 N TURQUOISE DR",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "86001",
"telephone_number": "928-774-5074",
"fax_number": "928-779-0884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAUFFMAN",
"first_name": "EDWARD",
"middle_name": "CHARLES",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-28",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "AZ",
"license": "33121",
"primary": false
},
{
"code": "207ND0101X",
"taxonomy_group": "",
"desc": "Dermatology, MOHS-Micrographic Surgery",
"state": "AZ",
"license": "33121",
"primary": true
},
{
"code": "207NS0135X",
"taxonomy_group": "",
"desc": "Dermatology, Procedural Dermatology",
"state": "AZ",
"license": "33121",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89184N",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.