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General NPI Number Information
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NPI Number | 1962410381
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Entity Type | Organization
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Legal Business Name | MARK JAFFE M D P A
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 03/12/2012
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Provider Practice Location Address
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Address Line | 1 SW 129TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1761
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Country | US
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Telephone | 954-441-9995
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Fax | 954-441-9033
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Provider Business Mailing Address
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Address Line | 1 SW 129TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1761
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Country | US
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Telephone | 954-441-9995
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Fax | 954-441-9033
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK JAFFE
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Credential | M.D.
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Telephone | 954-441-9995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0068879
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License Number State | FL
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