Provider Demographics
NPI:1770699175
Name:GHAFFAR, EJAZ (MD)
Entity type:Individual
Prefix:DR
First Name:EJAZ
Middle Name:
Last Name:GHAFFAR
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 1:203 WESTMORELAND CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5463
Mailing Address - Country:US
Mailing Address - Phone:407-348-8813
Mailing Address - Fax:407-348-4486
Practice Address - Street 1:203 WESTMORELAND CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5463
Practice Address - Country:US
Practice Address - Phone:407-348-8813
Practice Address - Fax:407-348-4486
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75563208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263207100Medicaid
FL263207100Medicaid
FLE2171YMedicare ID - Type Unspecified