Provider Demographics
NPI:1932509627
Name:KHAN, TANVEER (PA-C)
Entity Type:Individual
Prefix:
First Name:TANVEER
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11569 S HIGHWAY 6
Mailing Address - Street 2:PMB #209
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-4932
Mailing Address - Country:US
Mailing Address - Phone:281-428-8203
Mailing Address - Fax:
Practice Address - Street 1:7103 S PEEK RD STE 520
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3498
Practice Address - Country:US
Practice Address - Phone:281-712-7757
Practice Address - Fax:281-712-7758
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09248363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA09248OtherPA LICENSE NUMBER ( TMB)