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General NPI Number Information
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NPI Number | 1699739748
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Entity Type | Individual
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Provider Name | S. M. JAFRUL ISLAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2300 RAMSEY ST VA MEDICAL CENTER CHIEF, ANESTHESIOLOGY SERVICE
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-3856
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Country | US
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Telephone | 910-488-2120
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Fax |
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Provider Business Mailing Address
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Address Line | 4349 FERNCREEK DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-2543
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Country | US
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Telephone | 910-485-4483
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | NC
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