1104216852 NPI number — FATIMA E JAFFER MD PA

Table of content: ASHLEIGH JAYNE SCHAFER (NPI 1518538586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104216852 NPI number — FATIMA E JAFFER MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FATIMA E JAFFER MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1104216852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5758
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VILLA PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60181-5308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-967-5488
Provider Business Mailing Address Fax Number:
630-916-4575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12121 RICHMOND AVE
Provider Second Line Business Practice Location Address:
SUITE 420
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77082-2432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-967-5488
Provider Business Practice Location Address Fax Number:
630-916-4575
Provider Enumeration Date:
02/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JAFFER
Authorized Official First Name:
FATIMA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-967-4588

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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