Provider Demographics
NPI:1134175276
Name:JAFFER, AZUL S (MD)
Entity type:Individual
Prefix:
First Name:AZUL
Middle Name:S
Last Name:JAFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14406 AYERS ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7596
Mailing Address - Country:US
Mailing Address - Phone:281-980-8111
Mailing Address - Fax:
Practice Address - Street 1:6914 BRISBANE COURT
Practice Address - Street 2:SUITE 300
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-980-8111
Practice Address - Fax:281-980-8112
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN21282082S0099X
MA228031208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219377301Medicaid
TX0A5453Medicare PIN