Provider Demographics
NPI:1235199241
Name:KHAN, KHALID Y (MD)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:Y
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 1:141 N ROADRUNNER PKWY
Mailing Address - Street 2:SUITE 137
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-2006
Mailing Address - Country:US
Mailing Address - Phone:575-522-1974
Mailing Address - Fax:
Practice Address - Street 1:141 N ROADRUNNER PKWY
Practice Address - Street 2:SUITE 137
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-2006
Practice Address - Country:US
Practice Address - Phone:575-522-1974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM93-85208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM06866Medicaid
NMNM009B74OtherBCBS & HMO OF NM
NM202000493OtherPRESBYTERIAN HEALTH
020053292OtherRR MEDICARE
NM06866Medicaid
NM202000493OtherPRESBYTERIAN HEALTH