Healthcare Provider Details

I. General information

NPI: 1093754731
Provider Name (Legal Business Name): ASHFAQ A. KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WATER ST BLDG A
KERRVILLE TX
78028-3523
US

IV. Provider business mailing address

6800 W IH 10 STE 350
SAN ANTONIO TX
78201-2044
US

V. Phone/Fax

Practice location:
  • Phone: 830-896-3730
  • Fax: 830-792-4402
Mailing address:
  • Phone: 210-692-1414
  • Fax: 210-477-9097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberS5404
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number43185
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberS5404
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: