Healthcare Provider Details

I. General information

NPI: 1518495548
Provider Name (Legal Business Name): WAJIHA JURDI KHEIR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2017
Last Update Date: 06/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 ERWIN RD
DURHAM NC
27705-4699
US

IV. Provider business mailing address

749 9TH ST
DURHAM NC
27705-4891
US

V. Phone/Fax

Practice location:
  • Phone: 919-681-3937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number225232
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: