Provider Demographics
NPI:1346452018
Name:JAFARI, NEDA (DO)
Entity type:Individual
Prefix:
First Name:NEDA
Middle Name:
Last Name:JAFARI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 LONG POINT RD UNIT 55062
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77255-0815
Mailing Address - Country:US
Mailing Address - Phone:713-623-1788
Mailing Address - Fax:855-816-9662
Practice Address - Street 1:450 W MEDICAL CENTER BLVD STE 520
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4229
Practice Address - Country:US
Practice Address - Phone:713-623-1788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3703207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102738886Medicaid
PA1612461OtherGATEWAY
MD055670000Medicaid
PA2718719OtherHIGHMARK BLUE SHIELD
MD055670000Medicaid
PA244220Medicare PIN
MD055670000Medicaid
PA102738886Medicaid