Provider Demographics
NPI:1174603500
Name:KHOUW, RAYMOND S (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:S
Last Name:KHOUW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 W WHEATLAND RD
Mailing Address - Street 2:STE A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237
Mailing Address - Country:US
Mailing Address - Phone:972-709-0111
Mailing Address - Fax:973-709-0110
Practice Address - Street 1:3650 W WHEATLAND RD
Practice Address - Street 2:STE A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237
Practice Address - Country:US
Practice Address - Phone:972-709-0111
Practice Address - Fax:973-709-0110
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3516207VX0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032738901Medicaid
C17855Medicare UPIN