=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699807966
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IRFAN KHAN MD P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2007
-----------------------------------------------------
Last Update Date | 06/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9834 GLADES ROAD SUITE C5
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-470-1110
-----------------------------------------------------
Fax | 561-470-1184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9250 GLADES RD STE 110
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33434-3958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-470-1110
-----------------------------------------------------
Fax | 561-470-1184
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | IRFAN KHAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-470-1110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------