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General NPI Number Information
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NPI Number | 1255489597
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Entity Type | Organization
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Legal Business Name | M. KHAL ABOUDAN, MD
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 800 PRUDENTIAL DR
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8202
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Country | US
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Telephone | 904-396-5682
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Fax | 904-346-0864
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Provider Business Mailing Address
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Address Line | 820 PRUDENTIAL DR STE 713
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8209
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Country | US
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Telephone | 904-396-5682
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Fax | 904-346-0864
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Authorized Official
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Title or Position | MD
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Name | DR. M. KHAL ABOUDAN
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Credential | MD
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Telephone | 904-396-5682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | ME45711
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License Number State | FL
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