Provider Demographics
NPI:1023332616
Name:GAFFNEY, JON WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:WILLIAM
Last Name:GAFFNEY
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 1:9201 W. SUNSET BLVD
Mailing Address - Street 2:STE 510
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3706
Mailing Address - Country:US
Mailing Address - Phone:310-601-4660
Mailing Address - Fax:310-601-4666
Practice Address - Street 1:9201 W. SUNSET BLVD
Practice Address - Street 2:STE 510
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3706
Practice Address - Country:US
Practice Address - Phone:310-601-4660
Practice Address - Fax:310-601-4666
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC35643208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery