Provider Demographics
NPI:1821048422
Name:JAFFE, BURTON S (MD)
Entity Type:Individual
Prefix:DR
First Name:BURTON
Middle Name:S
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 1:2877 OAK POINT TER
Mailing Address - Street 2:DEPT 30535
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-2649
Mailing Address - Country:US
Mailing Address - Phone:618-579-9461
Mailing Address - Fax:
Practice Address - Street 1:2877 OAK POINT TER
Practice Address - Street 2:DEPT 30535
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2649
Practice Address - Country:US
Practice Address - Phone:618-579-9461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-110369207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110369Medicaid
I01914Medicare UPIN
IL214881037Medicare PIN
P00315320Medicare PIN
DE7181Medicare PIN
IL036110369Medicaid
213567Medicare PIN