Healthcare Provider Details

I. General information

NPI: 1699744052
Provider Name (Legal Business Name): JEFFREY M TAFFET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 N 32ND ST SUITE 220
PHOENIX AZ
85018-3953
US

IV. Provider business mailing address

9250 N 3RD ST SUITE 4010
PHOENIX AZ
85020-2437
US

V. Phone/Fax

Practice location:
  • Phone: 602-956-1250
  • Fax: 602-956-4766
Mailing address:
  • Phone: 602-633-3848
  • Fax: 602-633-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number16326
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: