Provider Demographics
NPI:1598764953
Name:KHAN, HAIDER (MD)
Entity Type:Individual
Prefix:DR
First Name:HAIDER
Middle Name:
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 1:7700 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-3024
Mailing Address - Country:US
Mailing Address - Phone:727-808-4800
Mailing Address - Fax:727-849-6337
Practice Address - Street 1:7700 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-3024
Practice Address - Country:US
Practice Address - Phone:727-808-4800
Practice Address - Fax:727-849-6337
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50383207Q00000X
NY158896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME50383OtherMEDICAL LICENSE
FLME50383OtherMEDICAL LICENSE