Provider Demographics
NPI:1366453540
Name:KHAN, JAFFER J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAFFER
Middle Name:J
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1764
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34284
Mailing Address - Country:US
Mailing Address - Phone:941-412-9787
Mailing Address - Fax:941-480-0388
Practice Address - Street 1:8421 POINTE LOOP DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293
Practice Address - Country:US
Practice Address - Phone:941-412-9787
Practice Address - Fax:941-480-0388
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83449207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0829675-012OtherCIGNA
00781OtherUNIVERSAL
06385OtherBLUE CROSS BLUE SHIELD
FL271075700Medicaid
271075700OtherMCD
4218642OtherAETNA
FL271075700Medicaid
C55021Medicare UPIN