Healthcare Provider Details

I. General information

NPI: 1023194982
Provider Name (Legal Business Name): YASSER KHALED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S ORANGE AVE
ORLANDO FL
32806-2134
US

IV. Provider business mailing address

1400 S ORANGE AVE
ORLANDO FL
32806-2134
US

V. Phone/Fax

Practice location:
  • Phone: 407-648-3800
  • Fax: 407-425-5203
Mailing address:
  • Phone: 407-648-3800
  • Fax: 407-425-5203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME104304
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: