Individual
DR. MUDUSSARA ASAD KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
224 MEMORIAL MEDICAL PKWY, SUITE 300, DAYTONA BEACH, FL 32117-5122
(386) 231-4060
(386) 615-9119
Mailing address
PO BOX 102222, ATTN: CREDENTIALING DEPT., ATLANTA, GA 30368-2222
(239) 274-8200
(239) 278-3350
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
ME114473
FL
207RX0202X
Medical Oncology Physician
Primary
ME114473
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008708200
—
FL
Enumeration date
06/05/2007
Last updated
08/09/2022
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