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General NPI Number Information
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NPI Number | 1740289180
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Entity Type | Individual
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Provider Name | SIDDIQA K KHAN MD
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Gender | Female
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 1833 BOULEVARD VA OUTPATIENT CLINIC
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City | JACKSONVILLE
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State | FL
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Zip | 32206-4382
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Country | US
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Telephone | 904-232-2751
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Fax | 904-301-2502
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Provider Business Mailing Address
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Address Line | 1833 BOULEVARD JACLSONVILLE VA OUTPATIENT CLINIC
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City | JACKSONVILLE
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State | FL
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Zip | 32206-4382
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Country | US
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Telephone | 904-232-2751
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Fax | 904-301-2502
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 90990
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License Number State | FL
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