Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | ME76931 | FL |
N | 208800000X | Urologist | ME76931 | FL |
NPI | 1073557864 |
---|---|
Provider Name | Waseem Khan |
First Address | Lake City, FL 32024-3457 |
Second Address | Lake City, FL 32024-3457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 09/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01693 | BCBS (01) | FL |
262534200 | (05) | FL |
279199 | AVMED (01) | FL |
830008471 | RR MCR (01) | FL |
PTAN 01693W | LINKED TO GROUP PTAN IE881A EFFECTIVE 07/01/15 (01) | FL |