Provider Demographics
NPI:1689296808
Name:SAJID KHAN MD LLC
Entity Type:Organization
Organization Name:SAJID KHAN MD LLC
Other - Org Name:JAX CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-420-7569
Mailing Address - Street 1:4100 SOUTHPOINT DR E STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8710
Mailing Address - Country:US
Mailing Address - Phone:904-420-7569
Mailing Address - Fax:847-221-6792
Practice Address - Street 1:4100 SOUTHPOINT DR E STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8710
Practice Address - Country:US
Practice Address - Phone:904-420-7569
Practice Address - Fax:847-221-6792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106420200Medicaid
FLACN1161OtherPHYSICIAN LICENSE
FL106420200Medicaid