Healthcare Provider Details

I. General information

NPI: 1932193687
Provider Name (Legal Business Name): IQTIDAR A KHAN M D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 BILL CLINTON DR SUITE 103
HOPE AR
71801-8661
US

IV. Provider business mailing address

302 BILL CLINTON DR SUITE 103
HOPE AR
71801-8661
US

V. Phone/Fax

Practice location:
  • Phone: 870-777-2970
  • Fax: 870-722-6619
Mailing address:
  • Phone: 870-777-2970
  • Fax: 870-722-6619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01072120A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE2934
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL9762
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD445904
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29405
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: