Provider Demographics
NPI:1033281191
Name:HAFFIZULLA, JASON MARC (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MARC
Last Name:HAFFIZULLA
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 1:7875 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33351-4353
Mailing Address - Country:US
Mailing Address - Phone:954-726-0099
Mailing Address - Fax:954-726-0047
Practice Address - Street 1:7875 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33351-4353
Practice Address - Country:US
Practice Address - Phone:954-726-0099
Practice Address - Fax:954-726-0047
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0086704207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH89985Medicare UPIN
FL29186ZMedicare PIN