Basic Information
| Provider Information | |||||||||
| NPI: | 1316193543 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAFFER | ||||||||
| FirstName: | ASIM | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16091 SWINGLEY RIDGE ROAD, SUITE 100 | ||||||||
| Address2: | LEGATUS EMERGENCY SERVICE | ||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184575200 | ||||||||
| FaxNumber: | 6185290568 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 WEST JACKSON | ||||||||
| Address2: | MEMORIAL HOSPITAL OF CARBONDALE ED | ||||||||
| City: | CARBONDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184575200 | ||||||||
| FaxNumber: | 6185290568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2008 | ||||||||
| LastUpdateDate: | 04/23/2009 | ||||||||
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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 | 207Q00000X | 036119029 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 036119029 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.