Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | OS-010681-L | PA |
NPI | 1043234008 |
---|---|
Provider Name | Dr. Fredric Jaffe |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19140-5103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 19/04/2018 |