Provider Demographics
NPI:1316193543
Name:JAFFER, ASIM K (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIM
Middle Name:K
Last Name:JAFFER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:16091 SWINGLEY RIDGE ROAD, SUITE 100
Mailing Address - Street 2:LEGATUS EMERGENCY SERVICE
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:618-457-5200
Mailing Address - Fax:618-529-0568
Practice Address - Street 1:405 WEST JACKSON
Practice Address - Street 2:MEMORIAL HOSPITAL OF CARBONDALE ED
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901
Practice Address - Country:US
Practice Address - Phone:618-457-5200
Practice Address - Fax:618-529-0568
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2009-04-23
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Provider Licenses
StateLicense IDTaxonomies
IL036119029207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213567004Medicare PIN