Provider Demographics
NPI:1851443337
Name:JAFFE, PETER JOHN (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:JAFFE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 111090
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-0119
Mailing Address - Country:US
Mailing Address - Phone:239-254-7778
Mailing Address - Fax:239-254-7718
Practice Address - Street 1:1865 VETERANS PARK DR
Practice Address - Street 2:SUITE # 101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0447
Practice Address - Country:US
Practice Address - Phone:239-254-7778
Practice Address - Fax:239-254-7718
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8375208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51541OtherBLUE CROSS BLUE SHIELD
FLDMERCOther4736770002
FL223383833OtherTAX IDENTIFICATION NUMBER
FLRAILROAD MEDICAREOther250014152
FLOS8375OtherSTATE LICENSE
FLDMERCOther4736770002
FL51541OtherBLUE CROSS BLUE SHIELD