Provider Demographics
NPI:1225006422
Name:KHAN, AZRA (MD)
Entity Type:Individual
Prefix:
First Name:AZRA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AZRA
Other - Middle Name:
Other - Last Name:SHAHEEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 17347
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33318-7347
Mailing Address - Country:US
Mailing Address - Phone:954-370-1053
Mailing Address - Fax:954-370-1533
Practice Address - Street 1:7100 W CAMINO REAL
Practice Address - Street 2:SUITE 301
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:772-924-2527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81344207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260288100Medicaid
FL57955XMedicare ID - Type Unspecified
FL260288100Medicaid