Provider Demographics
NPI:1508974189
Name:JAFFRI, ANWER (MD)
Entity Type:Individual
Prefix:
First Name:ANWER
Middle Name:
Last Name:JAFFRI
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:PO BOX 6040
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-6040
Mailing Address - Country:US
Mailing Address - Phone:812-645-3472
Mailing Address - Fax:812-231-1351
Practice Address - Street 1:315 E DAVIS DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4072
Practice Address - Country:US
Practice Address - Phone:812-645-3472
Practice Address - Fax:812-231-1351
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052586A207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0182857OtherUS DEPT OF LABOR
7164327OtherAETNA
440003696OtherRAILROAD MCARE PALAMETTO
N288075OtherHARMONY HEALTH PLAN IND
000000211347OtherANTHEM
IN200296430Medicaid
351904269121OtherCARESOURCE MEDICAID
458857OtherHEALTHLINK
IN200296430AOtherMOLINA HEALTHCARE MCAID
3530010003OtherCIGNA
H32270Medicare UPIN
IN200296430AOtherMOLINA HEALTHCARE MCAID
351904269121OtherCARESOURCE MEDICAID