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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 (MEDICAL DIRECTOR)
(817) 596-3700
Entity
Organization
Contact information
Practice address
2111 FORT WORTH HWY, WEATHERFORD, TX 76086-4834
(817) 596-3700
(866) 883-0041
Mailing address
PO BOX 1479, WEATHERFORD, TX 76086-1479
(817) 596-3700
(866) 883-0041
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M5284
TX
208000000X
Pediatrics Physician
M5284
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2176489-01
—
TX
05
—
2176489-02
—
TX
Enumeration date
03/11/2013
Last updated
03/11/2013
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