Provider Demographics
NPI:1689787707
Name:KHROMOV, ALEX DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:DAVID
Last Name:KHROMOV
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 1:1565 SAXON BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5876
Mailing Address - Country:US
Mailing Address - Phone:386-742-4343
Mailing Address - Fax:386-742-1323
Practice Address - Street 1:1565 SAXON BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5876
Practice Address - Country:US
Practice Address - Phone:386-742-4343
Practice Address - Fax:386-742-1323
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96564174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFLORIDA STATE LICENSOtherME96564