Provider Demographics
NPI:1114999695
Name:JAFARBAY, ASHKAN (MD)
Entity Type:Individual
Prefix:
First Name:ASHKAN
Middle Name:
Last Name:JAFARBAY
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 1:8251 W BROWARD BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-255-7310
Mailing Address - Fax:954-255-7311
Practice Address - Street 1:8251 W BROWARD BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2703
Practice Address - Country:US
Practice Address - Phone:954-255-7310
Practice Address - Fax:954-255-7311
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235093207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA174410OtherBCBS
WV2007511000Medicaid
VA010069688Medicaid
VAP00191270OtherRAILROAD MEDICARE
VAP00191270OtherRAILROAD MEDICARE
VA174410OtherBCBS