Healthcare Provider Details

I. General information

NPI: 1366453540
Provider Name (Legal Business Name): JAFFER J KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8421 POINTE LOOP DR
VENICE FL
34293
US

IV. Provider business mailing address

PO BOX 1764
VENICE FL
34284
US

V. Phone/Fax

Practice location:
  • Phone: 941-412-9787
  • Fax: 941-480-0388
Mailing address:
  • Phone: 941-412-9787
  • Fax: 941-480-0388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME83449
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: