Provider Demographics
NPI:1235352899
Name:KHATIB, KHALDUN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KHALDUN
Middle Name:
Last Name:KHATIB
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 JOE RAMSEY BLVD E # 205
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7852
Mailing Address - Country:US
Mailing Address - Phone:903-408-7980
Mailing Address - Fax:903-408-7989
Practice Address - Street 1:4211 JOE RAMSEY BLVD E STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7856
Practice Address - Country:US
Practice Address - Phone:903-408-7980
Practice Address - Fax:903-408-7989
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5774207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213701002Medicaid
TXTXB133294Medicare PIN