Provider Demographics
NPI:1720005812
Name:JAFFE, KENNETH AARON (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:AARON
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 1:2010 PATTON CHAPEL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-5782
Mailing Address - Country:US
Mailing Address - Phone:205-783-5511
Mailing Address - Fax:205-978-7776
Practice Address - Street 1:2010 PATTON CHAPEL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-5782
Practice Address - Country:US
Practice Address - Phone:205-783-5511
Practice Address - Fax:205-978-7776
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00011096207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
51107059OtherBCBS
AL9910112Medicaid
AL51005575OtherBCBS
AL51005575OtherBCBS
ALC75414Medicare UPIN
AL051522759JAFMedicare ID - Type Unspecified