Provider Demographics
NPI:1205857182
Name:KHAN, JABER A (MD)
Entity Type:Individual
Prefix:
First Name:JABER
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 1:550 WHITE OAK ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-4710
Mailing Address - Country:US
Mailing Address - Phone:336-625-1360
Mailing Address - Fax:336-625-1889
Practice Address - Street 1:550 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4710
Practice Address - Country:US
Practice Address - Phone:336-625-1360
Practice Address - Fax:336-625-1889
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1076OtherBCBS
NC89-1076VMedicaid
NC74787OtherMEDCOST
NC2245779Medicare ID - Type Unspecified
NC74787OtherMEDCOST