Provider Demographics
NPI:1881653723
Name:KHODR, BILAL (MD)
Entity Type:Individual
Prefix:DR
First Name:BILAL
Middle Name:
Last Name:KHODR
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:PO BOX 100296
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0296
Mailing Address - Country:US
Mailing Address - Phone:352-627-9350
Mailing Address - Fax:352-273-9054
Practice Address - Street 1:7046 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4723
Practice Address - Country:US
Practice Address - Phone:352-733-1770
Practice Address - Fax:352-372-5164
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072652207Q00000X, 208000000X
FLME72652208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271389600Medicaid
41469OtherBLUE CROSS BLUE SHIELD
FLDK320WMedicare PIN
41469OtherBLUE CROSS BLUE SHIELD