Healthcare Provider Details

I. General information

NPI: 1609368455
Provider Name (Legal Business Name): TALHA KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 SAMARITAN DR
LAS CRUCES NM
88001-1170
US

IV. Provider business mailing address

2560 SAMARITAN DR
LAS CRUCES NM
88001-1170
US

V. Phone/Fax

Practice location:
  • Phone: 575-800-3868
  • Fax:
Mailing address:
  • Phone: 575-800-3868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD2023-1143
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2023-1143
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: