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General NPI Number Information
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NPI Number | 1669525333
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Entity Type | Individual
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Provider Name | MOHAMMAD ASIF KHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 06/29/2018
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Provider Practice Location Address
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Address Line | 425 N LEE ST STE 204
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City | JACKSONVILLE
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State | FL
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Zip | 32204
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Country | US
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Telephone | 904-247-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 2160 COLONIAL BLVD
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City | FORT MYERS
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State | FL
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Zip | 33907-1410
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Country | US
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Telephone | 239-931-7342
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Fax | 239-931-7385
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | ME103595
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License Number State | FL
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