Healthcare Provider Details

I. General information

NPI: 1396724431
Provider Name (Legal Business Name): GHULAM JAFFERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 E 25TH ST EMERGENCY DEPARTMENT
HIALEAH FL
33013-3814
US

IV. Provider business mailing address

PO BOX 534221
ATLANTA GA
30353-4221
US

V. Phone/Fax

Practice location:
  • Phone: 305-693-6100
  • Fax: 904-346-0113
Mailing address:
  • Phone: 305-651-2270
  • Fax: 904-346-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME0072934
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: