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Organization
MEDPEDS MEDICAL CLINIC PA
Active
Organization
MEDPEDS MEDICAL CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NUSRAT A KHAN MD (CLINICAL DIRECTOR)
(817) 597-5632
Entity
Organization
Contact information
Practice address
2111 FORT WORTH HWY, WEATHERFORD, TX 76086-4834
(817) 596-3700
Mailing address
4925 CORRIENTE LN, BENBROOK, TX 76126-1853
(817) 597-5632
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00X703
MEDICARE GROUP PTAN
TX
Enumeration date
11/01/2006
Last updated
11/22/2022
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