MEDICARE: DR. AJAZ OMER KHAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	M0129	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043257645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AJAZ OMER KHAN M.D.

Provider Business Mailing Address
First Line	:	405 HOOD CT
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-2758
Country	:	US
Telephone Number	:	972-510-7539
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 INTERSTATE 30 STE 270
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75150-2601
Country	:	US
Telephone Number	:	972-288-9747
Fax Number	:	972-288-2610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/29/2025

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