Provider Demographics
NPI:1669525333
Name:KHAN, MOHAMMAD ASIF (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD ASIF
Middle Name:
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 1:2160 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:425 N LEE ST STE 204
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204
Practice Address - Country:US
Practice Address - Phone:904-247-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103595207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1317410OtherCIGNA
FL003704001Medicaid
FL349046OtherAVMED
FLP936573OtherOPTIMUM
FLP995026OtherFREEDOM HEALTH
FL617246OtherWELLCARE
FL1100390OtherCAREPLUS
FL14ET0OtherBCBS FL
FLP00986949OtherRAILROAD MEDICARE
FL304311OtherUNIVERSAL HEALTHCARE
GA003112552BMedicaid
FL9135781OtherAETNA
FL1193185OtherWELLCARE
FLP01593280OtherRR MEDICARE
GA003112552GMedicaid
FLP12273773OtherSIMPLY HEALTHCARE
FLP01593280OtherRR MEDICARE
FL003704001Medicaid
FLP936573OtherOPTIMUM