Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | ME57290 | FL |
NPI | 1013928282 |
---|---|
Provider Name | Dr. Tariq J Khan |
First Address | Venice, FL 34285 |
Second Address | Venice, FL 34293 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 13/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00782 | UNIVERSAL (01) | |
02625 | BLUE CROSS (01) | |
262101100 | (05) | FL |
2870035-016 | CIGNA (01) | FL |
4217880 | AETNA (01) | |
E56936 | (02) |