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General NPI Number Information
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NPI Number | 1750399077
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Entity Type | Individual
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Provider Name | KHIZAR AHSAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 5342 E HWY 83, C1
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City | RIO GRANDE CITY
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State | TX
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Zip | 78582
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Country | US
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Telephone | 956-488-9900
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Fax | 956-488-9910
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Provider Business Mailing Address
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Address Line | PO BOX 2880
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City | MISSION
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State | TX
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Zip | 78573-0049
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Country | US
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Telephone | 956-488-9900
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Fax | 956-488-9910
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | K5763
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License Number State | TX
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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 | K5763
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | K5763
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License Number State | TX
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