Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 24503 | AZ |
Y | 207R00000X | Internist | 24503 | AZ |
Y | 111NI0900X | Internist | 24503 | AZ |
NPI | 1336339175 |
---|---|
Provider Name | Dr. Mahmood Khan |
First Address | Kingman, AZ 86409-3567 |
Second Address | Kingman, AZ 86401-4698 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2007 |
Last Update Date | 27/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1285953950 | MEDICARE GROUP NPI (01) | |
1336339175 | NPPES (01) | AZ |
376691 | (05) | AZ |
G - 43767 | (02) |