Provider Demographics
NPI:1174769137
Name:ABDALLA, KHUZAM (MD)
Entity type:Individual
Prefix:
First Name:KHUZAM
Middle Name:
Last Name:ABDALLA
Suffix:
Gender:F
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:PO BOX 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-437-8655
Mailing Address - Fax:
Practice Address - Street 1:6300 REGIONAL PLZ STE 650
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5226
Practice Address - Country:US
Practice Address - Phone:325-692-5800
Practice Address - Fax:325-692-6111
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRS2008-0842208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics