Healthcare Provider Details

I. General information

NPI: 1588974380
Provider Name (Legal Business Name): FARDIN DJAFARI MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 11TH STREET
WICHITA FALLS TX
76301
US

IV. Provider business mailing address

1631 11TH STREET
WICHITA FALLS TX
76301
US

V. Phone/Fax

Practice location:
  • Phone: 940-687-4700
  • Fax: 940-687-5000
Mailing address:
  • Phone: 940-687-4700
  • Fax: 940-687-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: FARDIN S DJAFARI
Title or Position: OWNER/SOLE MEMBER
Credential: M.D.
Phone: 940-687-4700