Provider Demographics
NPI:1861890790
Name:KHATIB, AMER (MD)
Entity type:Individual
Prefix:DR
First Name:AMER
Middle Name:
Last Name:KHATIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMMAD
Other - Middle Name:AMER
Other - Last Name:KHATIB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1690 DUNLAWTON AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-8979
Mailing Address - Country:US
Mailing Address - Phone:386-271-2273
Mailing Address - Fax:
Practice Address - Street 1:1690 DUNLAWTON AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-8979
Practice Address - Country:US
Practice Address - Phone:386-271-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121927174400000X
PAMD067339L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist