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General NPI Number Information
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NPI Number | 1043257645
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Entity Type | Individual
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Provider Name | AJAZ OMER KHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 3400 INTERSTATE 30 STE 270
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City | MESQUITE
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State | TX
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Zip | 75150-2601
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Country | US
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Telephone | 972-288-9747
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Fax | 972-288-2610
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Provider Business Mailing Address
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Address Line | 405 HOOD CT
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City | COPPELL
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State | TX
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Zip | 75019-2758
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Country | US
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Telephone | 972-510-7539
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M0129
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License Number State | TX
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