Individual
KHALED RIAD KHASAWNEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4301 W. MARKHAM, SLOT #783, LITTLE ROCK, AR 72205
(501) 686-8000
Mailing address
4301 W. MARKHAM, SLOT #783, LITTLE ROCK, AR 72205
(501) 686-8000
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
E-4692
AR
207RP1001X
Pulmonary Disease Physician
E-4692
AR
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
E-4692
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101245603
STATE LICENSE
VA
05
—
1356370910
—
VA
05
—
7100076780
—
KY
01
—
C10456
TRAILBLAZER
VA
01
—
E-4692
LICENSE NUMBER
AR
01
—
P00733560
RAILROAD MEDICARE
VA
Enumeration date
07/03/2006
Last updated
04/20/2016
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