Provider Demographics
NPI:1326285552
Name:KHAN, SAMRA (MD)
Entity Type:Individual
Prefix:
First Name:SAMRA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAMRA
Other - Middle Name:
Other - Last Name:KHALID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6201 DALLAS PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3529
Mailing Address - Country:US
Mailing Address - Phone:972-640-1787
Mailing Address - Fax:
Practice Address - Street 1:6201 DALLAS PKWY STE 210
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3529
Practice Address - Country:US
Practice Address - Phone:972-640-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145516207R00000X
TX1415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine