Provider Demographics
NPI:1740289180
Name:KHAN, SIDDIQA K (MD)
Entity type:Individual
Prefix:
First Name:SIDDIQA
Middle Name:K
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1833 BOULEVARD
Mailing Address - Street 2:JACLSONVILLE VA OUTPATIENT CLINIC
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-4382
Mailing Address - Country:US
Mailing Address - Phone:904-232-2751
Mailing Address - Fax:904-301-2502
Practice Address - Street 1:1833 BOULEVARD
Practice Address - Street 2:VA OUTPATIENT CLINIC
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-4382
Practice Address - Country:US
Practice Address - Phone:904-232-2751
Practice Address - Fax:904-301-2502
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-04-07
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Provider Licenses
StateLicense IDTaxonomies
FL90990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3164176OtherCIGNA
FL392117OtherHEALTHEASE
FL2785404-00Medicaid
FL298827OtherAV MED
FL2064269OtherFIRST COAST ADVANTAGE
FL392117OtherHEALTHEASE