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General NPI Number Information
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NPI Number | 1922511898
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Entity Type | Organization
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Legal Business Name | WOUND CARE & RESEARCH CENTER OF NORTH TEXAS PLLC
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 12/21/2017
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Provider Practice Location Address
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Address Line | 502 N VALLEY PKWY STE 1
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City | LEWISVILLE
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State | TX
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Zip | 75067-3437
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Country | US
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Telephone | 972-316-0902
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Fax | 972-316-1161
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Provider Business Mailing Address
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Address Line | 502 N VALLEY PKWY STE 1
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City | LEWISVILLE
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State | TX
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Zip | 75067-3437
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Country | US
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Telephone | 972-316-0902
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Fax | 972-316-1161
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Authorized Official
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Title or Position | MANGING MEMBER
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Name | DR. JALIL AZIZ KHAN
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Credential | M.D.
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Telephone | 972-316-0902
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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 | J9128
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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