Healthcare Provider Details

I. General information

NPI: 1962024638
Provider Name (Legal Business Name): MAAZ A KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DIVISION ST
OREGON CITY OR
97045-1527
US

IV. Provider business mailing address

1500 DIVISION ST
OREGON CITY OR
97045-1527
US

V. Phone/Fax

Practice location:
  • Phone: 503-650-6270
  • Fax:
Mailing address:
  • Phone: 503-650-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number41333
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD229191
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: