Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | E8018 | TX |
Y | 2084N0400X | Neurologist | E8018 | TX |
NPI | 1124391198 |
---|---|
Provider Name | Mohamed Ahmed Khalil |
First Address | Webster, TX 77598-8538 |
Second Address | Webster, TX 77598-4820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2012 |
Last Update Date | 23/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8DN100 | BCBS (01) | TX |