Provider Demographics
NPI:1962057554
Name:JABERIAN DORAJI, ANITA
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:
Last Name:JABERIAN DORAJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 ANDREWS HWY APT 207
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4954
Mailing Address - Country:US
Mailing Address - Phone:806-317-6072
Mailing Address - Fax:
Practice Address - Street 1:407 KENT ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5858
Practice Address - Country:US
Practice Address - Phone:432-254-8846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14811363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant