Provider Demographics
NPI:1124016829
Name:KHIRFAN, MOHAMED WAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:WAEL J
Last Name:KHIRFAN
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:PO BOX 2510
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85214-2510
Mailing Address - Country:US
Mailing Address - Phone:602-432-0146
Mailing Address - Fax:480-821-9555
Practice Address - Street 1:24044 HIGHWAY 59 N
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1500
Practice Address - Country:US
Practice Address - Phone:281-674-7812
Practice Address - Fax:281-310-6602
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ967250Medicaid