MEDICARE: DR. GOHAR SHAMSHAD KHAN M.D.

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	207Q00000X	Family Medicine Physician	ME0029698	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568467256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GOHAR SHAMSHAD KHAN M.D.

Provider Business Mailing Address
First Line	:	905 BEVILLE RD
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-1705
Country	:	US
Telephone Number	:	386-767-9000
Fax Number	:	386-767-3761

Provider Business Practice Location Address
First Line	:	905 BEVILLE RD
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-1705
Country	:	US
Telephone Number	:	386-767-9000
Fax Number	:	386-767-3761

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	02/26/2016

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