Healthcare Provider Details

I. General information

NPI: 1760531461
Provider Name (Legal Business Name): MOHSIN H JAFFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 N CORPORATE LAKES BLVD SUITE 2
WESTON FL
33326
US

IV. Provider business mailing address

3410 STALLION LANE
WESTON FL
33331
US

V. Phone/Fax

Practice location:
  • Phone: 954-659-9690
  • Fax: 954-659-9694
Mailing address:
  • Phone: 954-580-8867
  • Fax: 954-580-8942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47178
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME47178
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: