Provider Demographics
NPI:1417189671
Name:KHAN, ZEESHAN TARIQ (MD)
Entity type:Individual
Prefix:DR
First Name:ZEESHAN
Middle Name:TARIQ
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 1:906 FALCON TRL
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-3836
Mailing Address - Country:US
Mailing Address - Phone:972-737-5000
Mailing Address - Fax:210-314-5044
Practice Address - Street 1:318 W FM 544 STE C4
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4652
Practice Address - Country:US
Practice Address - Phone:972-737-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60278638208M00000X, 208000000X
TXR68082083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA025904OtherKRMC L&I GROUP NUMBER
WA1417189671Medicaid