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General NPI Number Information
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NPI Number | 1033640784
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Entity Type | Individual
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Provider Name | SHEHRYAR KHALIQDINA MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 1500 S MAIN ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4917
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Country | US
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Telephone | 817-702-8621
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Fax |
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Provider Business Mailing Address
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Address Line | 2508 SANDERS CT
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City | BEDFORD
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State | TX
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Zip | 76021-1100
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 43092
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD2019-1066
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | U2896
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License Number State | TX
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