| Entity Name: | MARK JAFFE, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 16 Mar 1999 (26 years ago) |
| Document Number: | P99000023897 |
| FEI/EIN Number | 650925661 |
| Address: | 9900 STIRLING ROAD, COOPER CITY, FL, 33024, US |
| Mail Address: | 9900 STIRLING ROAD, COOPER CITY, FL, 33024, US |
| ZIP code: | 33024 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962410381 | 2006-08-03 | 2012-03-12 | 1 SW 129TH AVE, PEMBROKE PINES, FL, 330271761, US | 1 SW 129TH AVE, PEMBROKE PINES, FL, 330271761, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 954-441-9995 |
| Fax | 9544419033 |
Authorized person
| Name | DR. MARK JAFFE |
| Role | PRESIDENT |
| Phone | 9544419995 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME0068879 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 379137800 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | FR664A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JAFFE MARK M | Agent | 9900 STIRLING ROAD, COOPER CITY, FL, 33024 |
| Name | Role | Address |
|---|---|---|
| JAFFE MARK M | President | 9900 STIRLING ROAD, COOPER CITY, FL, 33024 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2019-03-01 | 9900 STIRLING ROAD, SUITE 102, COOPER CITY, FL 33024 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-09-06 | 9900 STIRLING ROAD, SUITE 102, COOPER CITY, FL 33024 | No data |
| CHANGE OF MAILING ADDRESS | 2018-09-06 | 9900 STIRLING ROAD, SUITE 102, COOPER CITY, FL 33024 | No data |
| REGISTERED AGENT NAME CHANGED | 2009-03-19 | JAFFE, MARK MD | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-02-02 |
| ANNUAL REPORT | 2022-02-27 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-01-19 |
| ANNUAL REPORT | 2019-03-01 |
| ANNUAL REPORT | 2018-03-18 |
| ANNUAL REPORT | 2017-01-15 |
| ANNUAL REPORT | 2016-02-04 |
| ANNUAL REPORT | 2015-01-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
