Provider Demographics
NPI:1346280070
Name:KHAN, BEHRAM ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:BEHRAM
Middle Name:ALI
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 1:711 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-5023
Mailing Address - Country:US
Mailing Address - Phone:361-343-2258
Mailing Address - Fax:
Practice Address - Street 1:711 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-5023
Practice Address - Country:US
Practice Address - Phone:361-343-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2669207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179720102Medicaid
TX179720101Medicaid
TX8G5803Medicare PIN
TX179720102Medicaid
TX179720101Medicaid