Provider Demographics
NPI:1528241734
Name:JEROME G. NAIFEH, M.D., P.A.
Entity type:Organization
Organization Name:JEROME G. NAIFEH, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:G
Authorized Official - Last Name:NAIFEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-361-0016
Mailing Address - Street 1:5949 SHERRY LN
Mailing Address - Street 2:STE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6532
Mailing Address - Country:US
Mailing Address - Phone:214-361-0016
Mailing Address - Fax:214-361-6484
Practice Address - Street 1:5949 SHERRY LN
Practice Address - Street 2:STE 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6532
Practice Address - Country:US
Practice Address - Phone:214-361-0016
Practice Address - Fax:214-361-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00804XMedicare PIN