Organization
MAGNOLIA PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BILAL KHODR MD (PROVIDER)
(386) 719-6500
Entity
Organization
Contact information
Practice address
1140 SW BASCOM NORRIS DR STE 104, LAKE CITY, FL 32025-1329
(386) 719-6500
(386) 719-6503
Mailing address
1140 SW BASCOM NORRIS DR STE 104, LAKE CITY, FL 32025-1329
(386) 719-6500
(386) 719-6503
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME72652
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
061823792
TRICARE
FL
Enumeration date
03/24/2008
Last updated
10/05/2012
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