Healthcare Provider Details

I. General information

NPI: 1851443337
Provider Name (Legal Business Name): PETER JOHN JAFFE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 VETERANS PARK DR SUITE # 101
NAPLES FL
34109-0447
US

IV. Provider business mailing address

PO BOX 111090
NAPLES FL
34108-0119
US

V. Phone/Fax

Practice location:
  • Phone: 239-254-7778
  • Fax: 239-254-7718
Mailing address:
  • Phone: 239-254-7778
  • Fax: 239-254-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS8375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: