Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 125.062505 | IL |
NPI | 1861731689 |
---|---|
Provider Name | Dr. Hosseinali Jafari |
First Address | Springfield, IL 62794-9662 |
Second Address | Springfield, IL 62701-1041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2013 |
Last Update Date | 14/02/2013 |