Healthcare Provider Details

I. General information

NPI: 1518348978
Provider Name (Legal Business Name): SIDRA KHALID M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 BROAD AVE STE 270
GULFPORT MS
39501-2404
US

IV. Provider business mailing address

1340 BROAD AVE STE 270
GULFPORT MS
39501-2404
US

V. Phone/Fax

Practice location:
  • Phone: 228-575-1234
  • Fax: 228-865-3038
Mailing address:
  • Phone: 228-575-1234
  • Fax: 228-867-4866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number27651
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: