Healthcare Provider Details

I. General information

NPI: 1083881239
Provider Name (Legal Business Name): GASTROENTEROLOGY AND LIVER DISEASES OF CENTRAL FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2541 S VOLUSIA AVE STE 300
ORANGE CITY FL
32763-9116
US

IV. Provider business mailing address

PO BOX 950177
LAKE MARY FL
32795-0177
US

V. Phone/Fax

Practice location:
  • Phone: 386-218-6893
  • Fax: 386-218-6895
Mailing address:
  • Phone: 386-218-6893
  • Fax: 386-218-6895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME90434
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberME90434
License Number StateFL

VIII. Authorized Official

Name: DR. SAAD M KHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 407-399-1311