Provider Demographics
NPI:1417063702
Name:KHAN, MOHAMMAD AFZAL (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:AFZAL
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 1:100 MEDICAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5674
Mailing Address - Country:US
Mailing Address - Phone:979-285-1231
Mailing Address - Fax:979-285-1651
Practice Address - Street 1:100 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5674
Practice Address - Country:US
Practice Address - Phone:979-285-1231
Practice Address - Fax:979-285-1651
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4239208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U6301OtherBLUE CROSS BLUE SHIELD
TX7262566OtherAETNA
TX1834301Medicaid
TX01038516OtherAMERIGROUP
TX22067OtherSELECTCARE OF TEXAS
TX22067OtherSELECTCARE OF TEXAS
TXI23483Medicare UPIN