Provider Demographics
NPI:1427005560
Name:KHATTAK, DOST MOHAMMAD (MD)
Entity Type:Individual
Prefix:MR
First Name:DOST
Middle Name:MOHAMMAD
Last Name:KHATTAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 WHITESPORT DR
Mailing Address - Street 2:STE 304
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3455
Mailing Address - Country:US
Mailing Address - Phone:256-880-0800
Mailing Address - Fax:256-882-3556
Practice Address - Street 1:333 WHITESPORT DR
Practice Address - Street 2:STE 304
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3455
Practice Address - Country:US
Practice Address - Phone:256-880-0800
Practice Address - Fax:256-882-3556
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL9080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C73571Medicare UPIN