Individual
MICHELLE LEE DAFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
5461
SD
207N00000X
Dermatology Physician
MD-35711
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000166004
RR MEDICARE
SD
01
—
0442046
MEDICARE
IA
05
—
5900470
—
SD
01
—
I12538
MEDICAID
IA
Enumeration date
02/24/2006
Last updated
12/10/2025
Update your record
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