Provider Demographics
NPI:1891794996
Name:RAFIQUE, JAMAL (MD)
Entity Type:Individual
Prefix:
First Name:JAMAL
Middle Name:
Last Name:RAFIQUE
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 1:2743 IMPERIA DR STE 202
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-8988
Mailing Address - Country:US
Mailing Address - Phone:346-368-2498
Mailing Address - Fax:348-368-2499
Practice Address - Street 1:2743 IMPERIA DR STE 202
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-8988
Practice Address - Country:US
Practice Address - Phone:346-368-2498
Practice Address - Fax:348-368-2499
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1052782084P0800X
TXN10872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN1087OtherLICENSE
TX2860587-01Medicaid
TXTXB126289Medicare PIN