Healthcare Provider Details

I. General information

NPI: 1265621411
Provider Name (Legal Business Name): HAFIZ SARFRAZ KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 W 8TH ST FL 15
JACKSONVILLE FL
32209-6533
US

IV. Provider business mailing address

580 W 8TH ST FL 15
JACKSONVILLE FL
32209-6533
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-1013
  • Fax: 904-244-4431
Mailing address:
  • Phone: 904-383-1013
  • Fax: 904-244-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43998
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME159810
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: