Healthcare Provider Details

I. General information

NPI: 1376603399
Provider Name (Legal Business Name): IAN MATHIAS JAFFEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 CALIFORNIA ST DEPARTMENT OF PATHOLOGY, 4TH FLOOR
SAN FRANCISCO CA
94118-1618
US

IV. Provider business mailing address

PO BOX 26060
FRESNO CA
93729-6060
US

V. Phone/Fax

Practice location:
  • Phone: 559-455-4000
  • Fax: 559-455-4007
Mailing address:
  • Phone: 559-455-4000
  • Fax: 559-455-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA93612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: