Individual
DR. OMAR ALI KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 W COUNTRY CLUB RD, SUITE # 220, ROSWELL, NM 88201-5202
(575) 625-1292
Mailing address
405 W COUNTRY CLUB RD, C/O MSO ADMINISTRATION, ROSWELL, NM 88201-5209
(575) 625-1292
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2007-0423
NM
207Q00000X
Family Medicine Physician
Primary
MD2009-0771
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
YIH843397355
BLUE CROSS BLUE SHIELD
NM
Enumeration date
08/01/2007
Last updated
01/17/2011
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