Provider Demographics
NPI:1215120712
Name:TEXAS FAMILY PRACTICE ASSOCIATES PA
Entity type:Organization
Organization Name:TEXAS FAMILY PRACTICE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHURSHID
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-686-4500
Mailing Address - Street 1:2540 N. GALLOWAY AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150
Mailing Address - Country:US
Mailing Address - Phone:972-686-4500
Mailing Address - Fax:972-686-9687
Practice Address - Street 1:2540 N. GALLOWAY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:972-686-4500
Practice Address - Fax:972-686-9687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4654207R00000X
TXTXJ4654207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083785801Medicaid
TX115422103Medicaid
TXF67733Medicare UPIN
TX85V261Medicare PIN
TX115422103Medicaid