Provider Demographics
NPI:1235421884
Name:JAFFER MEDICAL GROUP, PA
Entity Type:Organization
Organization Name:JAFFER MEDICAL GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAUZIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-433-3114
Mailing Address - Street 1:601 N FLAMINGO ROAD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028
Mailing Address - Country:US
Mailing Address - Phone:954-433-3114
Mailing Address - Fax:954-433-1179
Practice Address - Street 1:601 N FLAMINGO ROAD
Practice Address - Street 2:SUITE 304
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028
Practice Address - Country:US
Practice Address - Phone:954-433-3114
Practice Address - Fax:954-433-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL47178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD67078Medicare UPIN
FL04439AMedicare PIN