Provider Demographics
NPI:1164736955
Name:SHERIF, KHALED ALI B (MD)
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:ALI B
Last Name:SHERIF
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 1:3615 19TH ST
Mailing Address - Street 2:BOX 162
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1203
Mailing Address - Country:US
Mailing Address - Phone:806-725-4130
Mailing Address - Fax:806-723-7137
Practice Address - Street 1:3615 19TH ST
Practice Address - Street 2:BOX 162
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1203
Practice Address - Country:US
Practice Address - Phone:806-725-4130
Practice Address - Fax:806-723-7137
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
OK30131390200000X
TXQ3864207RH0002X
TXQ3964208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine