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General NPI Number Information
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NPI Number | 1659731487
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Entity Type | Individual
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Provider Name | SHAZIA KHAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 1736 E MAIN ST
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City | DOTHAN
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State | AL
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Zip | 36301
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Country | US
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Telephone | 334-712-9999
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 678402
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City | DALLAS
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State | TX
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Zip | 75267-8402
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Country | US
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Telephone | 334-712-9999
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Fax | 334-702-2119
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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 | MD.32116
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License Number State | AL
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