Provider Demographics
NPI:1376597815
Name:JAFRI, AHMED H (MD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:H
Last Name:JAFRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1438 S GRAND BLVD
Mailing Address - Street 2:MONTELEONE HALL
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1027
Mailing Address - Country:US
Mailing Address - Phone:314-977-4883
Mailing Address - Fax:314-977-4876
Practice Address - Street 1:305 W JACKSON ST STE 103
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1474
Practice Address - Country:US
Practice Address - Phone:618-351-4972
Practice Address - Fax:618-351-6522
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR1P302084N0400X, 2084N0600X, 2084V0102X
IL036.0783452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203014618Medicaid
MO0008516Medicare PIN
MO203014618Medicaid
MO203014618Medicaid
IL00008516Medicare PIN