Provider Demographics
NPI:1881648038
Name:DJAFARI, VALLA (MD)
Entity Type:Individual
Prefix:DR
First Name:VALLA
Middle Name:
Last Name:DJAFARI
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 1:4010 SANDY BROOK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1516
Mailing Address - Country:US
Mailing Address - Phone:512-651-2201
Mailing Address - Fax:512-651-2207
Practice Address - Street 1:4010 SANDY BROOK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1516
Practice Address - Country:US
Practice Address - Phone:512-651-2201
Practice Address - Fax:512-651-2207
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237522207W00000X
MDD0062707207W00000X
TXM9977207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F23832OtherMEDICARE PTAN
VA010134161Medicaid
VA010133840Medicaid
016548G51Medicare ID - Type Unspecified
TX8F23832OtherMEDICARE PTAN
863LK849Medicare ID - Type Unspecified
006532G26Medicare ID - Type Unspecified