Individual
GEORGE SOUHEL KHAMMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1017 12TH AVE, FORT WORTH, TX 76104-3915
(817) 334-2800
(817) 820-0094
Mailing address
1017 12TH AVE, FORT WORTH, TX 76104-3915
(817) 334-2800
(817) 820-0094
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
L4489
TX
207RI0011X
Interventional Cardiology Physician
Primary
L4489
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10008961
AMERIGROUP
TX
05
—
1558264-01
—
TX
05
—
1558264-02
—
TX
01
—
7462025
AETNA PROVIDER ID
—
01
—
8G2851
BCBS
TX
Enumeration date
05/11/2006
Last updated
10/11/2021
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