Provider Demographics
NPI:1528232014
Name:JAFARI, MITRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MITRA
Middle Name:
Last Name:JAFARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 HAYS STREET
Mailing Address - Street 2:STE B AND D
Mailing Address - City:LULING
Mailing Address - State:TX
Mailing Address - Zip Code:78648-3207
Mailing Address - Country:US
Mailing Address - Phone:830-875-7078
Mailing Address - Fax:830-875-7079
Practice Address - Street 1:130 HAYS STREET
Practice Address - Street 2:STE B AND D
Practice Address - City:LULING
Practice Address - State:TX
Practice Address - Zip Code:78648-3207
Practice Address - Country:US
Practice Address - Phone:830-875-7078
Practice Address - Fax:830-875-7079
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN6892208600000X
WAMD60402111208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery