Provider Demographics
NPI:1316621295
Name:KHAN, MUSTAFA DILAWAR (MD)
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:DILAWAR
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 1:3282 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701
Mailing Address - Country:US
Mailing Address - Phone:409-212-5000
Mailing Address - Fax:
Practice Address - Street 1:3080 COLLEGE STREET, BAPTIST HOSPITALS OF SOUTHEAST TEX
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701
Practice Address - Country:US
Practice Address - Phone:409-212-7463
Practice Address - Fax:409-212-7965
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program