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General NPI Number Information
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NPI Number | 1336304120
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Entity Type | Individual
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Provider Name | KHADIJAH A ABDURRAZAQ M.D, FAAP
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Gender | Female
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 801 E FLORIDA AVE
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City | MIDLAND
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State | TX
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Zip | 79701-8212
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Country | US
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Telephone | 432-685-0450
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Fax |
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Provider Business Mailing Address
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Address Line | 4411 W DENGAR AVE
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City | MIDLAND
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State | TX
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Zip | 79707-5305
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Country | US
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Telephone | 281-777-9302
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0071810
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | P4277
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License Number State | TX
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