Healthcare Provider Details

I. General information

NPI: 1477179075
Provider Name (Legal Business Name): JAMIL SHAFIQ AMLANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16811 SE MCGILLIVRAY BLVD
VANCOUVER WA
98683-3404
US

IV. Provider business mailing address

1401 E 8TH STREET
WESLACO TX
78596
US

V. Phone/Fax

Practice location:
  • Phone: 360-735-8100
  • Fax: 360-253-1781
Mailing address:
  • Phone: 956-968-8567
  • Fax: 956-969-1408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61361413
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: