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General NPI Number Information
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NPI Number | 1790778447
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Entity Type | Individual
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Provider Name | IRFAN A AFAQ M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/29/2005
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 2700 VISSING PARK RD
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-5989
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Country | US
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Telephone | 502-265-0491
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Fax | 502-222-8745
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Provider Business Mailing Address
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Address Line | PO BOX 265
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City | JEFFERSONVILLE
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State | IN
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Zip | 47131-0265
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Country | US
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Telephone | 502-265-0491
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Fax | 502-222-8745
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 37705
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 01057489A
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License Number State | IN
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