Healthcare Provider Details

I. General information

NPI: 1801031307
Provider Name (Legal Business Name): KHALID SHIRZAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 5TH AVE STE 400
SPOKANE WA
99204-2715
US

IV. Provider business mailing address

601 W 5TH AVE STE 400
SPOKANE WA
99204-2715
US

V. Phone/Fax

Practice location:
  • Phone: 509-344-2663
  • Fax: 509-624-9179
Mailing address:
  • Phone: 509-344-2663
  • Fax: 509-624-9179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number2009-00480
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMD60140499
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLL17811
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD60140499
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: