Healthcare Provider Details

I. General information

NPI: 1467470922
Provider Name (Legal Business Name): DAVID M JAFFE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

1 CHILDRENS PL C B 8116
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-2341
  • Fax: 314-454-4345
Mailing address:
  • Phone: 314-454-2341
  • Fax: 314-454-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberR3P30
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: