Provider Demographics
NPI:1639370018
Name:CHAFFIN, JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:CHAFFIN
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 1:9741 E TELEMETRY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-8510
Mailing Address - Country:US
Mailing Address - Phone:314-882-8123
Mailing Address - Fax:480-988-0102
Practice Address - Street 1:1525 S HIGLEY RD # 104-161
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4795
Practice Address - Country:US
Practice Address - Phone:314-882-8123
Practice Address - Fax:480-988-0102
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004016368390200000X
CAA1036562084P0800X
AZ600512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program