MEDICARE: KENNETH S. JAFFE, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	110233181	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	97340	OTHER	FL	BCBSFL
3	269348	OTHER	FL	AVMED

General Provider Information

NPI Number	:	1518210814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH S. JAFFE, M.D., P.A.

Provider Business Mailing Address
First Line	:	130 JOHN F KENNEDY DR
Second Line	:	SUITE 134
City	:	ATLANTIS
State	:	FL
Zip	:	33462-1141
Country	:	US
Telephone Number	:	561-439-0308
Fax Number	:	561-439-0371

Provider Business Practice Location Address
First Line	:	7138 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2970
Country	:	US
Telephone Number	:	561-439-0308
Fax Number	:	561-439-0371

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KENNETH SCOTT JAFFE
Credential	:	M.D.
Telephone Number	:	561-439-0308

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	10/24/2012

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