1508974189 NPI number — ANWER JAFFRI M.D.

Table of content: ANWER JAFFRI M.D. (NPI 1508974189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508974189 NPI number — ANWER JAFFRI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAFFRI
Provider First Name:
ANWER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508974189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6040
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TERRE HAUTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47802-6040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-645-3472
Provider Business Mailing Address Fax Number:
812-231-1351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 E DAVIS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47802-4072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-645-3472
Provider Business Practice Location Address Fax Number:
812-231-1351
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  01052586A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0182857 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7164327 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 440003696 . This is a "RAILROAD MCARE PALAMETTO" identifier . This identifiers is of the category "OTHER".
  • Identifier: N288075 . This is a "HARMONY HEALTH PLAN IND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000211347 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200296430 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 351904269121 . This is a "CARESOURCE MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 458857 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200296430A . This is a "MOLINA HEALTHCARE MCAID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 3530010003 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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