Healthcare Provider Details

I. General information

NPI: 1437155017
Provider Name (Legal Business Name): YOUSSEF KHALIL KHODOR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: YOUSSEF K KHODOR D.O.

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 HIGHWAY 44 W
INVERNESS FL
34453-3801
US

IV. Provider business mailing address

PO BOX 2066
LECANTO FL
34460-2066
US

V. Phone/Fax

Practice location:
  • Phone: 352-344-2273
  • Fax: 352-344-2204
Mailing address:
  • Phone: 352-563-0931
  • Fax: 352-563-0935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS8274
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: