Provider Demographics
NPI:1184699720
Name:JAFFER, FATIMA E (MD)
Entity type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:E
Last Name:JAFFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 RICHMOND AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2420
Mailing Address - Country:US
Mailing Address - Phone:281-967-5488
Mailing Address - Fax:
Practice Address - Street 1:12121 RICHMOND AVE STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2420
Practice Address - Country:US
Practice Address - Phone:281-967-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044403A207R00000X
IL036091346207R00000X
TXQ2676207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200114700BMedicaid
IN200114700BMedicaid
ILK15283/211111Medicare ID - Type Unspecified