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General NPI Number Information
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NPI Number | 1932221504
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE OF ORLANDO, INC.
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 11/07/2012
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Provider Practice Location Address
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Address Line | 5308 S JOHN YOUNG PKWY SUITE 100
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City | ORLANDO
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State | FL
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Zip | 32839-7362
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Country | US
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Telephone | 407-857-2144
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Fax | 407-857-9366
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Provider Business Mailing Address
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Address Line | 5308 S JOHN YOUNG PKWY SUITE 100
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City | ORLANDO
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State | FL
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Zip | 32839-7362
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Country | US
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Telephone | 407-857-2144
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Fax | 407-857-9366
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Authorized Official
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Title or Position | PRESIDENT
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Name | JASEEM A KHAN
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Credential | MD
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Telephone | 407-857-2144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME71184
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License Number State | FL
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