Provider Demographics
NPI:1700945250
Name:KHURANA, DAVE S (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVE
Middle Name:S
Last Name:KHURANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVE
Other - Middle Name:SINGH
Other - Last Name:KHURANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:102 MEDICAL PARK LANE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4975
Mailing Address - Country:US
Mailing Address - Phone:936-294-0971
Mailing Address - Fax:936-294-0977
Practice Address - Street 1:102 MEDICAL PARK LANE
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4975
Practice Address - Country:US
Practice Address - Phone:936-294-0971
Practice Address - Fax:936-294-0977
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1828207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278178600Medicaid
FL278178600Medicaid
FLAF588ZMedicare PIN