Healthcare Provider Details

I. General information

NPI: 1972122141
Provider Name (Legal Business Name): TAIMOOR AHMED KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 W NEWBERRY RD
GAINESVILLE FL
32605-4309
US

IV. Provider business mailing address

7728 YOSEMITE LN
PARKLAND FL
33067-2323
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-4000
  • Fax:
Mailing address:
  • Phone: 954-907-2094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME169528
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: