Provider Demographics
NPI:1063520062
Name:KHAN, MOHAMMAD SHAHBAZ (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:SHAHBAZ
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 1:203 WALLS DR STE 104
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7022
Mailing Address - Country:US
Mailing Address - Phone:817-556-5570
Mailing Address - Fax:
Practice Address - Street 1:203 WALLS DR STE 104
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7022
Practice Address - Country:US
Practice Address - Phone:817-556-5570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ1641208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY241533OtherLICENSE NUMBER