Provider Demographics
NPI:1033127873
Name:JAFARIAN, ALI (DO)
Entity Type:Individual
Prefix:MR
First Name:ALI
Middle Name:
Last Name:JAFARIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 S BUCKNER BLVD STE 133
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-4304
Mailing Address - Country:US
Mailing Address - Phone:214-398-4690
Mailing Address - Fax:214-398-4395
Practice Address - Street 1:1143 S. BUCKNER BLVD.
Practice Address - Street 2:STE 133
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-4304
Practice Address - Country:US
Practice Address - Phone:214-398-4690
Practice Address - Fax:214-398-4395
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0016207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0056AZOtherMEDICARE #
TX0056AZOtherMEDICARE #
89200BMedicare PIN