Provider Demographics
NPI:1942268578
Name:KHAN, ANWAR A (MD)
Entity Type:Individual
Prefix:MR
First Name:ANWAR
Middle Name:A
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 1:1800 SE 17TH STREET
Mailing Address - Street 2:BLD 800
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 SE 17TH STREET
Practice Address - Street 2:BLD 800
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-622-7268
Practice Address - Fax:352-622-6045
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25307600Medicaid
FL41548Medicare ID - Type Unspecified
FL25307600Medicaid