| Gohar S. Khan, M.d., P,a. | |
|
905 Beville Rd South Daytona FL 32119-1705 | |
| (386) 767-9000 | |
| (386) 767-3761 |
| Full Name | Gohar S. Khan, M.d., P,a. |
|---|---|
| Speciality | Family Medicine |
| Location | 905 Beville Rd, South Daytona, Florida |
| Authorized Official Name and Position | Dede Siebenaler (OFFICE MANAGER) |
| Authorized Official Contact | 3867679000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gohar S. Khan, M.d., P,a. 905 Beville Rd South Daytona FL 32119-1705 Ph: (386) 767-9000 | Gohar S. Khan, M.d., P,a. 905 Beville Rd South Daytona FL 32119-1705 Ph: (386) 767-9000 |
| NPI Number | 1083985873 |
|---|---|
| Provider Enumeration Date | 01/25/2012 |
| Last Update Date | 01/25/2012 |
| Medicare PECOS PAC ID | 5597650465 |
|---|---|
| Medicare Enrollment ID | O20040219000079 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083985873 | NPI | - | NPPES |
| 254205600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME0029698 (Florida) | Primary |
| Provider Name | Gohar Shamshad Khan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568467256 PECOS PAC ID: 6305731282 Enrollment ID: I20120210000274 |
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