Provider Demographics
NPI:1699844043
Name:GHAZNAVI, JAHANGIR HUSSAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAHANGIR
Middle Name:HUSSAIN
Last Name:GHAZNAVI
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 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:580-249-3027
Mailing Address - Fax:
Practice Address - Street 1:330 S 5TH STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5860
Practice Address - Country:US
Practice Address - Phone:580-249-3027
Practice Address - Fax:580-234-5970
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK178592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100060460AMedicaid