Basic Information
| Provider Information | |||||||||
| NPI: | 1700095494 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAFFER | ||||||||
| FirstName: | OMAR | ||||||||
| MiddleName: | ARIF | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 SE 164TH AVE | ||||||||
| Address2: | DEPT 358 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986839324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607886112 | ||||||||
| FaxNumber: | 3607886114 | ||||||||
| Practice Location | |||||||||
| Address1: | 2980 SQUALICUM PKWY | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607886112 | ||||||||
| FaxNumber: | 3607886114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 10/21/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 38422 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207R00000X | 38422 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 38422 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207R00000X | MD60448453 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | MD60448453 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | MD60448453 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 1700095494 | 05 | IA | MEDICAID | BP1-0026143 | 01 | INSTITUTIONAL PERMIT | OTHER |