Healthcare Provider Details

I. General information

NPI: 1457352031
Provider Name (Legal Business Name): DON R JAFFE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5165 MCCARTY LN
LAFAYETTE IN
47905-8764
US

IV. Provider business mailing address

2401 W UNIVERSITY AVE
MUNCIE IN
47303-3428
US

V. Phone/Fax

Practice location:
  • Phone: 765-838-5842
  • Fax: 765-838-4771
Mailing address:
  • Phone: 765-747-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number31230
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01074772A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: