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General NPI Number Information
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NPI Number | 1174507529
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Entity Type | Individual
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Provider Name | KENNETH SCOTT JAFFE M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 03/17/2017
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Provider Practice Location Address
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Address Line | 130 JOHN F KENNEDY DR SUITE 134
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City | ATLANTIS
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State | FL
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Zip | 33462-1141
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Country | US
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Telephone | 561-439-0308
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Fax | 561-328-6776
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Provider Business Mailing Address
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Address Line | 130 JOHN F KENNEDY DR SUITE 134
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City | ATLANTIS
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State | FL
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Zip | 33462-1141
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Country | US
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Telephone | 561-439-0308
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Fax | 561-328-6776
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME78885
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License Number State | FL
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