Provider Demographics
NPI:1780618561
Name:JAFFE, SCOTT H (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:H
Last Name:JAFFE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3384 WOODS EDGE CIR
Mailing Address - Street 2:#103
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-1367
Mailing Address - Country:US
Mailing Address - Phone:239-498-5760
Mailing Address - Fax:239-498-5763
Practice Address - Street 1:3384 WOODS EDGE CIR
Practice Address - Street 2:#103
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-1367
Practice Address - Country:US
Practice Address - Phone:239-498-5760
Practice Address - Fax:239-498-5763
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS-8523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF34339Medicare UPIN
FL13609ZMedicare ID - Type UnspecifiedPTAN
FLK3859Medicare ID - Type UnspecifiedPTAN