MEDICARE: JOSEPH ANTHONY KHAWLY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	K3773	TX
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	K3773	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1215919998	OTHER	TX	NPI
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215919998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH ANTHONY KHAWLY MD

Provider Business Mailing Address
First Line	:	PO BOX 4069
Second Line	:	DEPT. 4069-1
City	:	HOUSTON
State	:	TX
Zip	:	77210-4069
Country	:	US
Telephone Number	:	713-799-9975
Fax Number	:	713-799-1095

Provider Business Practice Location Address
First Line	:	2727 GRAMERCY ST
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77025-1633
Country	:	US
Telephone Number	:	713-799-9975
Fax Number	:	713-799-1095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	04/19/2017

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