Provider Demographics
NPI:1861482861
Name:KHAN, MASROOR A (MD)
Entity Type:Individual
Prefix:
First Name:MASROOR
Middle Name:A
Last Name:KHAN
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 540088
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77254-0088
Mailing Address - Country:US
Mailing Address - Phone:713-850-1190
Mailing Address - Fax:713-850-1327
Practice Address - Street 1:6550 FANNIN ST STE 2405
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2742
Practice Address - Country:US
Practice Address - Phone:832-831-6932
Practice Address - Fax:832-831-6987
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9583207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104988401Medicaid
H11266Medicare UPIN
TX104988401Medicaid