1346099181 NPI number — DR. IMRAN KHAN MD

Table of content: DR. IMRAN KHAN MD (NPI 1346099181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346099181 NPI number — DR. IMRAN KHAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAN
Provider First Name:
IMRAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346099181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
580 WEST 8TH STREET (TOWER 1, 9TH FLOOR)
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32209-6533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-383-1022
Provider Business Mailing Address Fax Number:
904-244-9789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
917 W WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-6527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-439-6464
Provider Business Practice Location Address Fax Number:
423-439-7118
Provider Enumeration Date:
05/15/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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