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Individual

DR. MASOOD A KHAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
6420 CLAYTON ROAD, ST LOUIS, MO 63117
(314) 768-8778
Mailing address
9941 CODDINGTON WAY, ST LOUIS, MO 63132
(314) 852-4946

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2004015678
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2004015678
MO TEMP STATE LICENSE NO.
MO
Enumeration date
05/02/2007
Last updated
07/08/2007
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