Basic Information
| Provider Information | |||||||||
| NPI: | 1093066516 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAFFE | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | ALEXANDRE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2010 59TH ST W | ||||||||
| Address2: | SUITE 2200 | ||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342094616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417945621 | ||||||||
| FaxNumber: | 9417611532 | ||||||||
| Practice Location | |||||||||
| Address1: | 2010 59TH ST W | ||||||||
| Address2: | SUITE 2200 | ||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342094616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417945621 | ||||||||
| FaxNumber: | 9417611532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2012 | ||||||||
| LastUpdateDate: | 02/01/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PAT9106858 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.