Provider Demographics
NPI:1417935693
Name:KHOURY, FARID (MD)
Entity Type:Individual
Prefix:DR
First Name:FARID
Middle Name:
Last Name:KHOURY
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:PO BOX 4290
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-0290
Mailing Address - Country:US
Mailing Address - Phone:940-766-1981
Mailing Address - Fax:
Practice Address - Street 1:2103 AVONDALE ST
Practice Address - Street 2:POB:4290
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-1213
Practice Address - Country:US
Practice Address - Phone:940-766-1981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9201208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB23933Medicare UPIN
TX85Z594Medicare ID - Type UnspecifiedMEDICARE