Healthcare Provider Details

I. General information

NPI: 1417312679
Provider Name (Legal Business Name): SHERIF SHOUKRY KHEDR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 FAIRWAY DRIVE
PALM BEACH GARDENS FL
33418
US

IV. Provider business mailing address

7101 FAIRWAY DRIVE
PALM BEACH GARDENS FL
33418
US

V. Phone/Fax

Practice location:
  • Phone: 561-515-1500
  • Fax:
Mailing address:
  • Phone: 561-515-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMFC1754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: