Provider Demographics
NPI:1699741405
Name:JAFFE, ANDREW TODD (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:TODD
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 1:900 VILLAGE SQUARE XING STE 290
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4552
Mailing Address - Country:US
Mailing Address - Phone:392-321-1802
Mailing Address - Fax:
Practice Address - Street 1:900 VILLAGE SQUARE XING STE 290
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4552
Practice Address - Country:US
Practice Address - Phone:392-321-1802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78335207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME78335OtherLICENSE
FLME 78335OtherMEDICAL LICENSE
FL51838ZOtherMEDICARE PTAN
FLME 78335OtherMEDICAL LICENSE
FLME78335OtherLICENSE