Provider Demographics
NPI:1033176524
Name:KHASTGIR, TERRANCE (MD)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:
Last Name:KHASTGIR
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 1:3433 NW 56TH ST
Mailing Address - Street 2:STE 660
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4462
Mailing Address - Country:US
Mailing Address - Phone:405-948-7571
Mailing Address - Fax:405-948-0537
Practice Address - Street 1:3433 NW 56TH ST STE 660
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4449
Practice Address - Country:US
Practice Address - Phone:405-947-3341
Practice Address - Fax:405-951-4342
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18133207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100056040AMedicaid
OKE68570Medicare UPIN
OK249341261Medicare ID - Type Unspecified