Healthcare Provider Details

I. General information

NPI: 1245433184
Provider Name (Legal Business Name): MUBEEN JAFRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N GRAHAM ST SUITE 300
PORTLAND OR
97227-1654
US

IV. Provider business mailing address

1200 NW MARSHALL ST #1317
PORTLAND OR
97209-3165
US

V. Phone/Fax

Practice location:
  • Phone: 503-460-0065
  • Fax: 503-460-0608
Mailing address:
  • Phone: 503-915-9838
  • Fax: 503-460-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD155230
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: