Provider Demographics
NPI:1003893728
Name:NAIFEH, JEROME G (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:G
Last Name:NAIFEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5637 CROWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8502
Mailing Address - Country:US
Mailing Address - Phone:214-632-2606
Mailing Address - Fax:
Practice Address - Street 1:10 MEDICAL PKWY STE 106
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-7838
Practice Address - Country:US
Practice Address - Phone:214-632-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE14712086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA36668Medicare UPIN
TX8C9850Medicare ID - Type UnspecifiedMEDICARE