Provider Demographics
NPI:1518348978
Name:KHALID, SIDRA (MD)
Entity Type:Individual
Prefix:
First Name:SIDRA
Middle Name:
Last Name:KHALID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1340 BROAD AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2404
Mailing Address - Country:US
Mailing Address - Phone:228-575-1234
Mailing Address - Fax:228-867-4866
Practice Address - Street 1:1340 BROAD AVE STE 270
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2404
Practice Address - Country:US
Practice Address - Phone:228-575-1234
Practice Address - Fax:228-867-4866
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS27651207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology