Healthcare Provider Details

I. General information

NPI: 1992400188
Provider Name (Legal Business Name): ALI KHURSHID CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7509 MARSHA SHARP FWY
LUBBOCK TX
79407-8202
US

IV. Provider business mailing address

PO BOX 676200
DALLAS TX
75267-6200
US

V. Phone/Fax

Practice location:
  • Phone: 806-744-7223
  • Fax: 806-740-3325
Mailing address:
  • Phone: 806-725-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number789789880
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: