Individual
TAZEEN H JAFAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1818 N MEADE ST, APPLETON, WI 54911-3454
(920) 735-7645
Mailing address
820 E GRANT ST, APPLETON, WI 54911-3483
(920) 731-4138
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
36342-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34673500
—
WI
01
—
4554481
ECFMG
—
Enumeration date
05/12/2006
Last updated
06/25/2013
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