Provider Demographics
NPI:1568551935
Name:JAFFE, PENNY (MD)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:JAFFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-8044
Mailing Address - Country:US
Mailing Address - Phone:713-873-4000
Mailing Address - Fax:713-873-4141
Practice Address - Street 1:2015 THOMAS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-8044
Practice Address - Country:US
Practice Address - Phone:713-873-4000
Practice Address - Fax:713-873-4141
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6861207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81Z646Medicare PIN
A66694Medicare UPIN