Provider Demographics
NPI:1952334955
Name:ALY, KHALID SAAD (MD)
Entity type:Individual
Prefix:DR
First Name:KHALID
Middle Name:SAAD
Last Name:ALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KHALID
Other - Middle Name:SAAD
Other - Last Name:ABDEL-GAWAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:562 S ELLIOTT ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-6411
Mailing Address - Country:US
Mailing Address - Phone:918-824-8000
Mailing Address - Fax:918-825-5505
Practice Address - Street 1:562 S ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-6411
Practice Address - Country:US
Practice Address - Phone:918-824-8000
Practice Address - Fax:918-825-5505
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20428207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100226700AMedicaid
248426610Medicare ID - Type Unspecified
OK100226700AMedicaid