Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 37277 | OK |
N | 208000000X | Pediatrician | MD60278638 | WA |
NPI | 1417189671 |
---|---|
Provider Name | Dr. Zeeshan Tariq Khan |
First Address | San Antonio, TX 78232-2009 |
Second Address | Garland, TX 75044 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2009 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
025904 | KRMC L&I GROUP NUMBER (01) | WA |
1417189671 | (05) | WA |