NPIMap

Organization Active NPI

Gohar S. Khan, M.D., P,a.

  • Family Medicine Physician
  • South Daytona, FL
National Provider Identifier
1083985873
Registry record updated Jan 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME0029698 Issued in FL
Legal business name
GOHAR S. KHAN, M.D., P,A.
Practice address
905 Beville Rd
South Daytona, FL 32119-1705
Phone
(386) 767-9000
Fax
(386) 767-3761
NPI assigned
Jan 25, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miss Dede Siebenaler
Title
Office Manager
Phone
(386) 767-9000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X ME0029698 FL Primary

Addresses

Primary practice location

905 Beville Rd
South Daytona, FL 32119-1705

Mailing address

905 Beville Rd
South Daytona, FL 32119-1705
Phone (386) 767-9000

Other identifiers 1

IdentifierTypeStateIssuer
254205600MedicaidFL

National Provider Directory

National Provider Directory

Locations

905 Beville Rd
South Daytona, FL 32119
Phone (386) 767-9000

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327449600000",
    "number": "1083985873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 BEVILLE RD",
            "city": "SOUTH DAYTONA",
            "state": "FL",
            "postal_code": "321191705",
            "telephone_number": "386-767-9000",
            "fax_number": "386-767-3761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 BEVILLE RD",
            "city": "SOUTH DAYTONA",
            "state": "FL",
            "postal_code": "321191705",
            "telephone_number": "386-767-9000",
            "fax_number": "386-767-3761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOHAR S. KHAN, M.D., P,A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-25",
        "last_updated": "2012-01-25",
        "status": "A",
        "authorized_official_last_name": "SIEBENALER",
        "authorized_official_first_name": "DEDE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "386-767-9000",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0029698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254205600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Daytona, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.