Provider Demographics
NPI:1396708756
Name:KHATEEB, MAZIN A (MD)
Entity type:Individual
Prefix:
First Name:MAZIN
Middle Name:A
Last Name:KHATEEB
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 1:205 W BOUTZ RD
Mailing Address - Street 2:BLDG #1
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3262
Mailing Address - Country:US
Mailing Address - Phone:575-532-7000
Mailing Address - Fax:575-532-7006
Practice Address - Street 1:3235 TRAWOOD DR.
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:915-545-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3679208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AJ339OtherBCBS OF TX
P00080411OtherRR MEDICARE
TX089636702OtherSUPERIOR HEALTH
TX089636702OtherEL PASO FIRST
TX089636702Medicaid
NM201012625OtherPRESBYTERIAN HEALTH
4364295OtherAETNA
NM201012625OtherPRESBYTERIAN HEALTH
TX089636702Medicaid