Provider Demographics
NPI:1215919998
Name:KHAWLY, JOSEPH ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:KHAWLY
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 4069
Mailing Address - Street 2:DEPT. 4069-1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4069
Mailing Address - Country:US
Mailing Address - Phone:713-799-9975
Mailing Address - Fax:713-799-1095
Practice Address - Street 1:2727 GRAMERCY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1633
Practice Address - Country:US
Practice Address - Phone:713-799-9975
Practice Address - Fax:713-799-1095
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3773207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1343584-06Medicaid
TX134358408Medicaid
TX134358410Medicaid
TX134358414Medicaid
TX134358413Medicaid
TX1215919998OtherNPI
TX134358412Medicaid
TX134358411Medicaid
TX134358414Medicaid
TX8A7668Medicare PIN
TX134358412Medicaid
TX134358408Medicaid
G23665Medicare UPIN
TX180030741Medicare PIN
TX134358413Medicaid
TX8A7644Medicare PIN
TX1343584-06Medicaid