Provider Demographics
NPI:1972585081
Name:GHAFOOR, NASRULLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:NASRULLAH
Middle Name:
Last Name:GHAFOOR
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 1:4466 SWILCAN BRIDGE LN N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-5617
Mailing Address - Country:US
Mailing Address - Phone:904-281-0944
Mailing Address - Fax:904-281-9806
Practice Address - Street 1:4466 SWILCAN BRIDGE LN N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-5617
Practice Address - Country:US
Practice Address - Phone:904-281-0944
Practice Address - Fax:904-281-9806
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68887208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253275100Medicaid
FL28349AMedicare ID - Type Unspecified
FL253275100Medicaid