Provider Demographics
NPI:1750302782
Name:JAAFAR, MAZEN (MD)
Entity type:Individual
Prefix:MR
First Name:MAZEN
Middle Name:
Last Name:JAAFAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5000 KY ROUTE 321 STE 3124
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9113
Mailing Address - Country:US
Mailing Address - Phone:606-886-7635
Mailing Address - Fax:606-886-7680
Practice Address - Street 1:5000 KY ROUTE 321 STE 3124
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9113
Practice Address - Country:US
Practice Address - Phone:606-886-7635
Practice Address - Fax:606-886-7680
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY30466208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64304660Medicaid
KYF84159Medicare UPIN