Provider Demographics
NPI:1275549529
Name:KHAN, SANOBER M (MD)
Entity Type:Individual
Prefix:
First Name:SANOBER
Middle Name:M
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 METROPOLIS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-3111
Mailing Address - Country:US
Mailing Address - Phone:512-823-4226
Mailing Address - Fax:512-823-4166
Practice Address - Street 1:7901 METROPOLIS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-3111
Practice Address - Country:US
Practice Address - Phone:512-823-4336
Practice Address - Fax:512-823-4166
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171341401Medicaid
TX171341403Medicaid
TX171341404Medicaid
TX171341402Medicaid
TX8J9707Medicare PIN
TXP00309877Medicare PIN
TX171341402Medicaid
TXTXB154853Medicare PIN
TXP01154993Medicare PIN
TX171341401Medicaid