Individual
PAUL PATRICK KOFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903
(401) 444-3600
(401) 444-3124
Mailing address
800 WASHINGTON ST., BOX 1013: PROVIDER ENROLLMENT, BOSTON, MA 02111-1552
(617) 636-8153
(617) 636-1465
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
MD16186
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821433053
—
RI
Enumeration date
05/01/2013
Last updated
05/15/2025
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