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NPI Code Detail

MEDICARE: DR. JACK JAFFE PSYD

MEDICARE: DR. JACK JAFFE PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist31536TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
286707AOTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1144334269
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK JAFFE PSYD
Provider Business Mailing Address
First Line : 7422 FOXWORTH DR
Second Line :
City : DALLAS
State : TX
Zip : 75248-3038
Country : US
Telephone Number : 972-693-5485
Fax Number :
Provider Business Practice Location Address
First Line : 6330 LYNDON B JOHNSON FWY STE 130
Second Line :
City : DALLAS
State : TX
Zip : 75240-6443
Country : US
Telephone Number : 972-693-5485
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 11/21/2022

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