Healthcare Provider Details

I. General information

NPI: 1679564587
Provider Name (Legal Business Name): SALEH JAAFAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 HWY 90E
CASTROVILLE TX
78009
US

IV. Provider business mailing address

1051 US HIGHWAY 90 E
CASTROVILLE TX
78009-5210
US

V. Phone/Fax

Practice location:
  • Phone: 830-931-3336
  • Fax: 830-931-3508
Mailing address:
  • Phone: 830-931-3336
  • Fax: 830-931-3508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK0839
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: