Provider Demographics
NPI:1437155017
Name:KHODOR, YOUSSEF KHALIL (DO)
Entity Type:Individual
Prefix:DR
First Name:YOUSSEF
Middle Name:KHALIL
Last Name:KHODOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:YOUSSEF
Other - Middle Name:K
Other - Last Name:KHODOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 2066
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34460-2066
Mailing Address - Country:US
Mailing Address - Phone:352-563-0931
Mailing Address - Fax:352-563-0935
Practice Address - Street 1:1907 HIGHWAY 44 W
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3801
Practice Address - Country:US
Practice Address - Phone:352-344-2273
Practice Address - Fax:352-344-2204
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8274207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51756OtherBCBS
FL264799100Medicaid
773114OtherMAILHANDLERS
FL51756OtherBCBS
695956OtherTUFTS
P00397539OtherRR GBA MEDICARE
FL51756OtherBCBS
773114OtherMAILHANDLERS
51756XMedicare PIN