MEDICARE: ABBAS KHOSHDEL 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	J5800	TX

General Provider Information

NPI Number	:	1285946947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBAS KHOSHDEL M.D.

Provider Business Mailing Address
First Line	:	799 CAMINO FRANCISCA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87506-6100
Country	:	US
Telephone Number	:	505-303-8440
Fax Number	:

Provider Business Practice Location Address
First Line	:	799 CAMINO FRANCISCA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87506-6100
Country	:	US
Telephone Number	:	505-303-8440
Fax Number	:

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

Provider Enumeration Date	:	07/10/2010
Last Update Date	:	03/17/2018

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