Healthcare Provider Details

I. General information

NPI: 1982259917
Provider Name (Legal Business Name): AMENAH JAFAREY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65201-5276
US

IV. Provider business mailing address

400 N KEENE ST
COLUMBIA MO
65201-6626
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-4438
  • Fax:
Mailing address:
  • Phone: 573-882-4438
  • Fax: 573-884-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2019026651
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2019026651
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: