Provider Demographics
NPI:1649565292
Name:KHAN, BOBBY (DO)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CANANDAIGUA ST
Mailing Address - Street 2:
Mailing Address - City:SHORTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14548-9763
Mailing Address - Country:US
Mailing Address - Phone:585-289-3560
Mailing Address - Fax:
Practice Address - Street 1:15 CANANDAIGUA ST
Practice Address - Street 2:
Practice Address - City:SHORTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14548-9763
Practice Address - Country:US
Practice Address - Phone:585-289-3560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-12
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine