| Entity Name: | GOHAR S. KHAN, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 16 May 1997 (28 years ago) |
| Document Number: | P97000043559 |
| FEI/EIN Number | 593516850 |
| Address: | 905 BEVILLE ROAD, SOUTH DAYTONA, FL, 32119 |
| Mail Address: | 905 BEVILLE ROAD, SOUTH DAYTONA, FL, 32119 |
| ZIP code: | 32119 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083985873 | 2012-01-25 | 2012-01-25 | 905 BEVILLE RD, SOUTH DAYTONA, FL, 321191705, US | 905 BEVILLE RD, SOUTH DAYTONA, FL, 321191705, US | |||||||||||||||||||||||||
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| Phone | +1 386-767-9000 |
| Fax | 3867673761 |
Authorized person
| Name | MISS DEDE SIEBENALER |
| Role | OFFICE MANAGER |
| Phone | 3867679000 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME0029698 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 254205600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ZISKIND & ARVIN, P.A. | Agent | 444 BRICKELL AVENUE SUITE 905, MIAMI, FL, 33131 |
| Name | Role | Address |
|---|---|---|
| KHAN GOHAR S | President | 905 BEVILLE ROAD, SOUTH DAYTONA, FL, 32119 |
| Name | Role | Address |
|---|---|---|
| KHAN GOHAR S | Director | 905 BEVILLE ROAD, SOUTH DAYTONA, FL, 32119 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-10 |
| ANNUAL REPORT | 2023-02-03 |
| ANNUAL REPORT | 2022-02-10 |
| ANNUAL REPORT | 2021-03-29 |
| ANNUAL REPORT | 2020-04-01 |
| ANNUAL REPORT | 2019-02-18 |
| ANNUAL REPORT | 2018-02-07 |
| ANNUAL REPORT | 2017-01-16 |
| ANNUAL REPORT | 2016-04-19 |
| ANNUAL REPORT | 2015-01-11 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
