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General NPI Number Information
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NPI Number | 1982295564
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Entity Type | Individual
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Provider Name | MOHAMMAD KHALID MD
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Gender | Male
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 300 HEALTH PARK BLVD STE 4000
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-3704
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Country | US
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Telephone | 904-217-2148
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 840009
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32080-0009
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Country | US
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Telephone | 904-217-2148
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Fax |
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 59999
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License Number State | FL
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