Healthcare Provider Details

I. General information

NPI: 1427431782
Provider Name (Legal Business Name): MOHAMMAD JAFFAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 06/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 TURKEY LAKE RD
ORLANDO FL
32819
US

IV. Provider business mailing address

3090 CARUSO CT STE 20
ORLANDO FL
32806-8510
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-8500
  • Fax:
Mailing address:
  • Phone: 321-841-2605
  • Fax: 407-426-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN21687
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME135565
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: