Provider Demographics
NPI:1851851992
Name:MATAR, KHALED ABDALLA (MD)
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:ABDALLA
Last Name:MATAR
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 1:13021 TERRACE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-3007
Mailing Address - Country:US
Mailing Address - Phone:813-373-4143
Mailing Address - Fax:
Practice Address - Street 1:1601 W 40TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6069
Practice Address - Country:US
Practice Address - Phone:870-541-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program