Provider Demographics
NPI:1770710196
Name:EL-KHOURY, BASHIR (MD)
Entity type:Individual
Prefix:DR
First Name:BASHIR
Middle Name:
Last Name:EL-KHOURY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 VINCENT STREET
Mailing Address - Street 2:SPACE BASE DELTA 1
Mailing Address - City:PETERSON SPACE FORCE BASE
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:559 VINCENT STREET
Practice Address - Street 2:SPACE BASE DELTA 1
Practice Address - City:PETERSON SPACE FORCE BASE
Practice Address - State:CO
Practice Address - Zip Code:80914-1541
Practice Address - Country:US
Practice Address - Phone:719-552-1627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101248040207RN0300X
TXT16932083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN