=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174876692
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SYED RAZA JAFRI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2012
-----------------------------------------------------
Last Update Date | 10/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7900 CAMBRIDGE ST # 22-2D
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77054-5502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-748-2067
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7900 CAMBRIDGE STREET # 22-2D
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-748-2067
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | P3542
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------