Provider Demographics
NPI:1861401127
Name:KHAN, TARIQ ALI (MD)
Entity type:Individual
Prefix:
First Name:TARIQ
Middle Name:ALI
Last Name:KHAN
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 1:1308 PALUXY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5689
Mailing Address - Country:US
Mailing Address - Phone:817-579-3978
Mailing Address - Fax:817-579-3977
Practice Address - Street 1:1308 PALUXY RD STE 300
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5689
Practice Address - Country:US
Practice Address - Phone:817-579-3978
Practice Address - Fax:817-579-3977
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4929207RG0100X
MS15809174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR132145001Medicaid
TN3815396Medicaid
MS00118746Medicaid
AR132145001Medicaid
TN3150548OtherBLUE CROSS
MS00118746Medicaid
TN3150548OtherBLUE CROSS
TN3815396Medicaid