Provider Demographics
NPI:1174507529
Name:JAFFE, KENNETH SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:SCOTT
Last Name:JAFFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 JOHN F KENNEDY DR
Mailing Address - Street 2:SUITE 134
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1141
Mailing Address - Country:US
Mailing Address - Phone:561-439-0308
Mailing Address - Fax:561-328-6776
Practice Address - Street 1:130 JOHN F KENNEDY DR
Practice Address - Street 2:SUITE 134
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1141
Practice Address - Country:US
Practice Address - Phone:561-439-0308
Practice Address - Fax:561-328-6776
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78885207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2423088OtherAETNA
FL2165459OtherWELLCARE
LAH04908OtherVISTA
FL002008791-002OtherUNITED HEALTH CARE
FL1023545OtherPHCS
FL2509859OtherGHI
FL651050544OtherHEALTH CARE DISTRIC
FLP-2364360OtherFIRST HEALTH
FL0746706OtherCIGNA
FL51774OtherBLUE CROSS BLUE SHEILD
FL5269380OtherCCN
FL162142OtherUNIVERSAL HEALTHCARE
FL260146000Medicaid
FL269348OtherAVMED
FLP-2364360OtherFIRST HEALTH
FL651050544OtherHEALTH CARE DISTRIC