=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962455824
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARY F JAFFE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 09/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2801 NE 213TH ST STE 1006
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-945-7433
-----------------------------------------------------
Fax | 305-933-0895
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2801 NE 213TH ST STE 1006
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-945-7433
-----------------------------------------------------
Fax | 305-933-0895
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | ME38393
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------