Provider Demographics
NPI:1093754731
Name:KHAN, ASHFAQ A (MD)
Entity Type:Individual
Prefix:
First Name:ASHFAQ
Middle Name:A
Last Name:KHAN
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 1:6800 W IH 10 STE 350
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-2044
Mailing Address - Country:US
Mailing Address - Phone:210-692-1414
Mailing Address - Fax:210-477-9097
Practice Address - Street 1:1001 WATER ST BLDG A
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3523
Practice Address - Country:US
Practice Address - Phone:830-896-3730
Practice Address - Fax:830-792-4402
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5404207RI0011X, 207RC0000X
NV13289207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1093754731Medicaid
NVCO732XMedicare PIN
NV1093754731Medicaid