Provider Demographics
NPI:1629049275
Name:JAFFE, TODD B (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:B
Last Name:JAFFE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8095 SPYGLASS HILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940
Mailing Address - Country:US
Mailing Address - Phone:321-757-0577
Mailing Address - Fax:321-757-0474
Practice Address - Street 1:8095 SPYGLASS HILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-757-0577
Practice Address - Fax:321-757-0474
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0039795207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069221200Medicaid
FL61286ZMedicare PIN
D57174Medicare UPIN