Dastagir a Khan MD PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME82073 Issued in FL

Legal business name

DASTAGIR A KHAN MD PA

Practice address

800 Prudential Dr
Jacksonville, FL 32207-8202

Phone

(904) 955-7190

NPI assigned

May 25, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Dastagir A Khan, MD

Title

Owner

Phone

(904) 955-7190

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307059200000",
    "number": "1790996288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 BARONY DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322256119",
            "telephone_number": "904-955-7190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 PRUDENTIAL DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078202",
            "telephone_number": "904-955-7190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DASTAGIR A KHAN MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2011-06-03",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "DASTAGIR",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-955-7190",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME82073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270290800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA",
            "identifier": "57641",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "D06811",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Mixon Darracott, PHARM.D.
• Ryan M Darragh, PT, DPT, ATC
• Darla Darty
• Karen Dash
• Jayanth Dasika, M.D.
• Dastagir a Khan MD, PA
• Jaraad Dattadeen, MD
• Danielle Dattilo, LMHC
• Carrie Daub
• Felicha Daughtry

• Internal Medicine Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2011; 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.