Provider Demographics
NPI:1699733378
Name:KHURSHID, MUNAWWER (MD)
Entity type:Individual
Prefix:DR
First Name:MUNAWWER
Middle Name:
Last Name:KHURSHID
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 1:1204 N MOUND ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4027
Mailing Address - Country:US
Mailing Address - Phone:936-568-8425
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:1018 N MOUND ST STE 201
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4434
Practice Address - Country:US
Practice Address - Phone:936-564-3538
Practice Address - Fax:936-564-3546
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4930207R00000X, 2084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX476715YMAFMedicare PIN
TX8FR375OtherBCBS
TX476715YMAFMedicare PIN
TX042224805Medicaid
TX75-2616977-095OtherTRICARE