Provider Demographics
NPI:1083648158
Name:JAFFE, WILLIAM M (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:JAFFE
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Gender:M
Credentials:DO
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Mailing Address - Street 1:4444 N 32ND STREET
Mailing Address - Street 2:SUITE 175
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3956
Mailing Address - Country:US
Mailing Address - Phone:602-952-0002
Mailing Address - Fax:602-224-9119
Practice Address - Street 1:1890 E FLORENCE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5642
Practice Address - Country:US
Practice Address - Phone:520-381-8850
Practice Address - Fax:520-381-8851
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-03-06
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Provider Licenses
StateLicense IDTaxonomies
AZ005180207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ441137Medicaid
AZZ131371Medicare PIN