Provider Demographics
NPI:1306953559
Name:MASOOD H KHAN MD PA
Entity type:Organization
Organization Name:MASOOD H KHAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MASOOD
Authorized Official - Middle Name:H
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-780-9616
Mailing Address - Street 1:6725 CEDAR RIDGE DR
Mailing Address - Street 2:STE 1
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7515
Mailing Address - Country:US
Mailing Address - Phone:813-780-9616
Mailing Address - Fax:813-788-6866
Practice Address - Street 1:6725 CEDAR RIDGE DR
Practice Address - Street 2:STE 1
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-7515
Practice Address - Country:US
Practice Address - Phone:813-780-9616
Practice Address - Fax:813-788-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88950261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG86910Medicare UPIN
FLK8399Medicare PIN