Provider Demographics
NPI:1700021508
Name:DAVENPORT PEDIATRICS CLERMONT, P.A.
Entity Type:Organization
Organization Name:DAVENPORT PEDIATRICS CLERMONT, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIL
Authorized Official - Middle Name:H
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-394-7728
Mailing Address - Street 1:1528 SUNRISE PLAZA DR STE 1
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-6203
Mailing Address - Country:US
Mailing Address - Phone:352-394-7728
Mailing Address - Fax:352-394-6369
Practice Address - Street 1:1528 SUNRISE PLAZA DR STE 1
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-6203
Practice Address - Country:US
Practice Address - Phone:352-394-7728
Practice Address - Fax:352-394-6369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty