Provider Demographics
NPI:1386930667
Name:JAFRI, RIZWAN (DO)
Entity type:Individual
Prefix:
First Name:RIZWAN
Middle Name:
Last Name:JAFRI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 S VAL VISTA DR STE 116
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2154
Mailing Address - Country:US
Mailing Address - Phone:480-507-5678
Mailing Address - Fax:480-507-5677
Practice Address - Street 1:2680 S VAL VISTA DR STE 116
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2154
Practice Address - Country:US
Practice Address - Phone:480-507-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102206419207RG0100X
IN02004549A208M00000X
IL125060442390200000X
AZ7629207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILRES000Medicare UPIN