Provider Demographics
NPI:1043257645
Name:KHAN, AJAZ OMER (MD)
Entity type:Individual
Prefix:DR
First Name:AJAZ
Middle Name:OMER
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:405 HOOD CT
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2758
Mailing Address - Country:US
Mailing Address - Phone:972-510-7539
Mailing Address - Fax:
Practice Address - Street 1:3400 INTERSTATE 30 STE 270
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2601
Practice Address - Country:US
Practice Address - Phone:972-288-9747
Practice Address - Fax:972-288-2610
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0129207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177146101Medicaid
TX8G0847Medicare ID - Type Unspecified