Provider Demographics
NPI:1972981843
Name:KHAN, SHAMYAL (DO)
Entity type:Individual
Prefix:
First Name:SHAMYAL
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:DO
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 23189
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-3189
Mailing Address - Country:US
Mailing Address - Phone:254-537-0911
Mailing Address - Fax:254-537-0313
Practice Address - Street 1:364 RICHLAND WEST CIR STE A
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7919
Practice Address - Country:US
Practice Address - Phone:254-537-0911
Practice Address - Fax:254-537-0313
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX593771207R00000X
TXR7507207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR7507OtherLICENSE