Provider Demographics
NPI:1629222161
Name:ZOHRA R KHAN
Entity type:Organization
Organization Name:ZOHRA R KHAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZOHRA
Authorized Official - Middle Name:RASHID
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:817-545-2771
Mailing Address - Street 1:2275 WESTPARK CT STE 102
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3746
Mailing Address - Country:US
Mailing Address - Phone:817-545-2771
Mailing Address - Fax:817-545-2772
Practice Address - Street 1:2275 WESTPARK CT STE 102
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3746
Practice Address - Country:US
Practice Address - Phone:817-545-2771
Practice Address - Fax:817-545-2772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0074261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114421402Medicaid
TX0A0394Medicare PIN
TX114421402Medicaid