Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 31544 | MN |
NPI | 1063485928 |
---|---|
Provider Name | Jeffrry P Jaffe |
First Address | Minneapolis, MN 55425-4516 |
Second Address | St Paul, MN 55101-2502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 03/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
096587100 | (05) | MN |
D83713 | (02) |