Healthcare Provider Details

I. General information

NPI: 1235323619
Provider Name (Legal Business Name): AHSAN JAFFAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 E BARNETT RD
MEDFORD OR
97504-8332
US

IV. Provider business mailing address

2640 E BARNETT RD # 333
MEDFORD OR
97504-4301
US

V. Phone/Fax

Practice location:
  • Phone: 541-282-6770
  • Fax: 541-282-6771
Mailing address:
  • Phone: 541-282-6770
  • Fax: 541-282-6771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberPENDING
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: