Organization
GOHAR S. KHAN, M.D., P,A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS DEDE SIEBENALER (OFFICE MANAGER)
(386) 767-9000
Entity
Organization
Contact information
Practice address
905 BEVILLE RD, SOUTH DAYTONA, FL 32119-1705
(386) 767-9000
(386) 767-3761
Mailing address
905 BEVILLE RD, SOUTH DAYTONA, FL 32119-1705
(386) 767-9000
(386) 767-3761
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME0029698
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
254205600
—
FL
Enumeration date
01/25/2012
Last updated
01/25/2012
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