Provider Demographics
NPI:1215919881
Name:KHAN, ABDUL NASIR (MD)
Entity type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:NASIR
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:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402
Mailing Address - Country:US
Mailing Address - Phone:580-223-8614
Mailing Address - Fax:580-223-2561
Practice Address - Street 1:800 W HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-2524
Practice Address - Country:US
Practice Address - Phone:580-223-8614
Practice Address - Fax:580-223-2561
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20569207RN0300X
TXK8251207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029932302Medicaid
TXK8251OtherTX MEDICAL LICENSE
TXP99741272OtherRR MEDICARE TX
OK100178120AMedicaid
TXK8251OtherTX MEDICAL LICENSE
G24259Medicare UPIN
TX00268JMedicare ID - Type Unspecified