Healthcare Provider Details

I. General information

NPI: 1275713935
Provider Name (Legal Business Name): UBAID ASLAM KHOKHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2007
Last Update Date: 03/07/2023
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1543 KINGSLEY AVE STE 14
ORANGE PARK FL
32073-4570
US

IV. Provider business mailing address

1543 KINGSLEY AVE STE 14
ORANGE PARK FL
32073-4570
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-6977
  • Fax: 904-269-0870
Mailing address:
  • Phone: 904-264-6977
  • Fax: 904-269-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME112832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: