Provider Demographics
NPI:1205866753
Name:ALI JAFFAR MD PA
Entity Type:Organization
Organization Name:ALI JAFFAR MD PA
Other - Org Name:AMARILLO CARDIOVASCULAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-352-7200
Mailing Address - Street 1:PO BOX 51225
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-1225
Mailing Address - Country:US
Mailing Address - Phone:806-352-7200
Mailing Address - Fax:806-352-3411
Practice Address - Street 1:3501 S SONCY RD STE 144
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6406
Practice Address - Country:US
Practice Address - Phone:806-352-7200
Practice Address - Fax:806-352-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0085AVOtherBCBS
TX178992701Medicaid
TXDC2124OtherRR PTAN
TXDC2124OtherRR PTAN