MEDICARE: DR. SARFARAZ A JASDANWALA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	2015021629	MO
2	207R00000X	Internal Medicine Physician	190524	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036.162657	OTHER	IL	STATE LICENSE
2	336.120566	OTHER	IL	LICENSED PHYSICIAN CONTROLLED SUBSTANCE
3	036.162657	OTHER	IL	LICENSED PHYSICIAN CONTROLLED SUBSTANCE
4	C190524	OTHER	CA	STATE LICENSE
5	2015021629	OTHER	MO	STATE LICENSE
6	2500025774	OTHER	MO	CDS

General Provider Information

NPI Number	:	1851646665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARFARAZ A JASDANWALA MD

Provider Business Mailing Address
First Line	:	1003 HAUCK DR
Second Line	:
City	:	ROLLA
State	:	MO
Zip	:	65401-2584
Country	:	US
Telephone Number	:	573-466-2056
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 HAUCK DR
Second Line	:
City	:	ROLLA
State	:	MO
Zip	:	65401-2584
Country	:	US
Telephone Number	:	573-247-1487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2012
Last Update Date	:	02/04/2026

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Directions to “ DR. SARFARAZ A JASDANWALA MD” Practice Location

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