Provider Demographics
NPI:1568706554
Name:JAZZAR, AHMAD S (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:S
Last Name:JAZZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5617 NORMANDY TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-1823
Mailing Address - Country:US
Mailing Address - Phone:405-974-0218
Mailing Address - Fax:405-755-1166
Practice Address - Street 1:5617 NORMANDY TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-1823
Practice Address - Country:US
Practice Address - Phone:405-974-0218
Practice Address - Fax:405-755-1166
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK18466207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology