MEDICARE: MASOOD H KHAN MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	ME88950	FL

General Provider Information

NPI Number	:	1306953559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASOOD H KHAN MD PA

Provider Business Mailing Address
First Line	:	6725 CEDAR RIDGE DR
Second Line	:	STE 1
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-7515
Country	:	US
Telephone Number	:	813-780-9616
Fax Number	:	813-788-6866

Provider Business Practice Location Address
First Line	:	6725 CEDAR RIDGE DR
Second Line	:	STE 1
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-7515
Country	:	US
Telephone Number	:	813-780-9616
Fax Number	:	813-788-6866

Authorized Official
Title or Position	:	M.D.
Name	:	DR. MASOOD H KHAN
Credential	:	M.D.
Telephone Number	:	813-780-9616

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	11/05/2007

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