Provider Demographics
NPI:1477084440
Name:KHUBAIB, MOHAMMAD U (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:U
Last Name:KHUBAIB
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 1:1741 E BARDIN RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-4836
Mailing Address - Country:US
Mailing Address - Phone:817-702-8700
Mailing Address - Fax:
Practice Address - Street 1:1741 E BARDIN RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-4836
Practice Address - Country:US
Practice Address - Phone:817-702-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10870500207R00000X
390200000X
TXT7971207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program