Organization
DAVENPORT PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIA CRISTINA KHAN MD (CO-OWNER)
(863) 421-1855
Entity
Organization
Contact information
Practice address
103 PARK PLACE BLVD, DAVENPORT, FL 33837-6858
(863) 421-1855
(863) 421-2624
Mailing address
103 PARK PLACE BLVD, DAVENPORT, FL 33837-6858
(863) 421-1855
(863) 421-2624
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275150000
—
FL
Enumeration date
02/13/2007
Last updated
02/07/2017
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