Provider Demographics
NPI:1255326344
Name:JAFARNIA, MOHAMED REZA (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:REZA
Last Name:JAFARNIA
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 1:4301 GARTH RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3153
Mailing Address - Country:US
Mailing Address - Phone:281-420-0808
Mailing Address - Fax:281-420-0233
Practice Address - Street 1:4301 GARTH RD
Practice Address - Street 2:SUITE 209
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3900
Practice Address - Country:US
Practice Address - Phone:281-420-0808
Practice Address - Fax:281-420-0233
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7984207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00RT55Medicare ID - Type UnspecifiedMEDICARE
TXB23723Medicare UPIN