Healthcare Provider Details

I. General information

NPI: 1174507529
Provider Name (Legal Business Name): KENNETH SCOTT JAFFE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 JOHN F KENNEDY DR SUITE 134
ATLANTIS FL
33462-1141
US

IV. Provider business mailing address

130 JOHN F KENNEDY DR SUITE 134
ATLANTIS FL
33462-1141
US

V. Phone/Fax

Practice location:
  • Phone: 561-439-0308
  • Fax: 561-328-6776
Mailing address:
  • Phone: 561-439-0308
  • Fax: 561-328-6776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME78885
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: