Organization
SHUJAAT A KHAN M D P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHUJAAT A KHAN MD (PRESIDENT)
(817) 335-6363
Entity
Organization
Contact information
Practice address
800 8TH AVE, STE 404, FORT WORTH, TX 76104
(817) 335-6363
(817) 870-1222
Mailing address
800 8TH AVE, STE 404, FORT WORTH, TX 76104
(817) 335-6363
(817) 870-1222
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
E5132
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200N93T
—
TX
01
—
4119241
AETNA
TX
01
—
86W281
BCBS
TX
Enumeration date
11/23/2007
Last updated
09/07/2010
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