Organization
BREVARD PAIN MANAGEMENT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TODD B JAFFE M.D. (PRESIDENT)
(321) 757-0577
Entity
Organization
Contact information
Practice address
1832 GARDEN ST, TITUSVILLE, FL 32796-3200
(321) 264-1961
(321) 264-0472
Mailing address
PO BOX 129, TITUSVILLE, FL 32781-0129
(321) 264-1961
(321) 264-0472
Taxonomy
Speciality
Code
Description
License number
State
207LA0401X
Addiction Medicine (Anesthesiology) Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0692212-00
—
FL
01
—
CM3459
RAILROAD MEDICARE PTAN
FL
Enumeration date
08/10/2006
Last updated
10/25/2010
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