=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629049275
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TODD BARRETT JAFFE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2006
-----------------------------------------------------
Last Update Date | 10/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4830 STATE ROUTE 260 103
-----------------------------------------------------
City | LAKESIDE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-368-7346
-----------------------------------------------------
Fax | 926-495-5514
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1925 PASSAGE DR
-----------------------------------------------------
City | SHOW LOW
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85901-6905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-368-7346
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 71525
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207LA0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 71525
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------