Healthcare Provider Details

I. General information

NPI: 1962864181
Provider Name (Legal Business Name): JIBRAN NAVAID KHAN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2016
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 OCOEE APOPKA RD
APOPKA FL
32703-9210
US

IV. Provider business mailing address

2100 OCOEE APOPKA RD
APOPKA FL
32703-9210
US

V. Phone/Fax

Practice location:
  • Phone: 407-599-2700
  • Fax:
Mailing address:
  • Phone: 407-599-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS16055
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: