Provider Demographics
NPI:1013910108
Name:KHOURY, JOSEPH D (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
Last Name:KHOURY
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 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4009
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12025207ZP0102X
TN37611207ZP0102X
TXP1660207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104677769Medicaid
OH2523308Medicaid
GA351017839AMedicaid
KY64079866Medicaid
AL009951825Medicaid
IA0585265Medicaid
AR152669001Medicaid
MO209140508Medicaid
NC7615208Medicaid
OK200026870AMedicaid
LA422400000Medicaid
TN5440416Medicaid
KS200376220AMedicaid
TX293283201 (MDACC)Medicaid
IN200476640AMedicaid
SCQ37611Medicaid
NJ0059269Medicaid
MS09559099Medicaid
WI82578600Medicaid
TX8DE741OtherBCBS (MDACC)
AL009951825Medicaid
SCQ37611Medicaid