Provider Demographics
NPI:1114903010
Name:JAFFEE, JAY BENNETT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:BENNETT
Last Name:JAFFEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0865
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:12222 MERIT DR STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-3294
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0842207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125082106Medicaid
TX83753KOtherBCBS
TX8EH335OtherBCBS TX
TX125082109OtherMEDICAID CSHCN
TX83753KOtherBCBS
TX125082110Medicaid
TX125082103Medicaid
TX8EH335OtherBCBS TX
TX125082106Medicaid
TX125082108Medicaid
TX125082110Medicaid
TX125082108Medicaid
TXP083753K9Medicaid
TX125082109OtherMEDICAID CSHCN
TX89165KMedicare ID - Type Unspecified607K
TX125082103Medicaid