Provider Demographics
NPI:1578982609
Name:JAFFE, JONATHAN TYLER (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:TYLER
Last Name:JAFFE
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 1:16811 SOUTHWEST FWY STE 300
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4728
Mailing Address - Country:US
Mailing Address - Phone:281-275-0897
Mailing Address - Fax:
Practice Address - Street 1:16811 SOUTHWEST FWY STE 300
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4728
Practice Address - Country:US
Practice Address - Phone:281-275-0897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5815207P00000X, 207RC0200X
NC2018-01001207P00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine