Provider Demographics
NPI:1386810190
Name:JAFFE, DENYSE (MD)
Entity type:Individual
Prefix:
First Name:DENYSE
Middle Name:
Last Name:JAFFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12535 NW 67TH DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1952
Mailing Address - Country:US
Mailing Address - Phone:954-775-0222
Mailing Address - Fax:
Practice Address - Street 1:12535 NW 67TH DR
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-1952
Practice Address - Country:US
Practice Address - Phone:954-775-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106777207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program