Healthcare Provider Details

I. General information

NPI: 1396784393
Provider Name (Legal Business Name): NAYER N. KHOUZAM, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 OAKWATER CIR SUITE 3
ORLANDO FL
32806-6200
US

IV. Provider business mailing address

3802 OAKWATER CIR SUITE 3
ORLANDO FL
32806-6200
US

V. Phone/Fax

Practice location:
  • Phone: 407-650-0000
  • Fax: 407-650-8757
Mailing address:
  • Phone: 407-650-0000
  • Fax: 407-650-8757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number48829
License Number StateFL

VIII. Authorized Official

Name: NAYER N. KHOUZAM
Title or Position: PHYSICIAN/PRESIDENT
Credential: MD
Phone: 407-650-0000