Provider Demographics
NPI:1336304120
Name:ABDURRAZAQ, KHADIJAH A (MD, FAAP)
Entity Type:Individual
Prefix:DR
First Name:KHADIJAH
Middle Name:A
Last Name:ABDURRAZAQ
Suffix:
Gender:F
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 W DENGAR AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5305
Mailing Address - Country:US
Mailing Address - Phone:281-777-9302
Mailing Address - Fax:
Practice Address - Street 1:801 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-8212
Practice Address - Country:US
Practice Address - Phone:432-685-0450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0071810208000000X
TXP4277208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics