Provider Demographics
NPI:1487600342
Name:KHAN, MUHAMMAD AZHER (MD)
Entity type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:AZHER
Last Name:KHAN
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 1:1550 W ROSEDALE ST
Mailing Address - Street 2:606
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7438
Mailing Address - Country:US
Mailing Address - Phone:817-810-9222
Mailing Address - Fax:817-810-9202
Practice Address - Street 1:1550 W ROSEDALE ST
Practice Address - Street 2:606
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7438
Practice Address - Country:US
Practice Address - Phone:817-810-9222
Practice Address - Fax:817-810-9202
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0068ETOtherBCBS
G16090Medicare UPIN
TX00978LMedicare ID - Type Unspecified