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1619927373

NPI Code Detail

MEDICARE: GEORGE SOUHEL KHAMMAR MD

MEDICARE: GEORGE SOUHEL KHAMMAR MD

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	207RC0000X	Cardiovascular Disease Physician	L4489	TX
2	207RI0011X	Interventional Cardiology Physician	L4489	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
2	10008961	OTHER	TX	AMERIGROUP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	7462025	OTHER		AETNA PROVIDER ID
5	8G2851	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1619927373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE SOUHEL KHAMMAR MD

Provider Business Mailing Address
First Line	:	1017 12TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3915
Country	:	US
Telephone Number	:	817-334-2800
Fax Number	:	817-820-0094

Provider Business Practice Location Address
First Line	:	1017 12TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3915
Country	:	US
Telephone Number	:	817-334-2800
Fax Number	:	817-820-0094

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	10/11/2021

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Directions to “ GEORGE SOUHEL KHAMMAR MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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