Provider Demographics
NPI:1336413426
Name:KHURI, NADIR T (MD)
Entity Type:Individual
Prefix:DR
First Name:NADIR
Middle Name:T
Last Name:KHURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NADER
Other - Middle Name:T
Other - Last Name:KHOURY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3284 WHITE HAWK RD
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027
Mailing Address - Country:US
Mailing Address - Phone:760-715-7660
Mailing Address - Fax:760-758-2201
Practice Address - Street 1:3284 WHITE HAWK RD.
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027
Practice Address - Country:US
Practice Address - Phone:760-715-7660
Practice Address - Fax:760-758-2201
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53740208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB23934Medicare UPIN