Provider Demographics
NPI:1649262643
Name:KHOSHNEJAD, FERIDOON (MD)
Entity type:Individual
Prefix:
First Name:FERIDOON
Middle Name:
Last Name:KHOSHNEJAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 GARTH RD
Mailing Address - Street 2:# 303
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3153
Mailing Address - Country:US
Mailing Address - Phone:281-428-1793
Mailing Address - Fax:281-420-9604
Practice Address - Street 1:4301 GARTH RD
Practice Address - Street 2:# 303
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3156
Practice Address - Country:US
Practice Address - Phone:281-428-1793
Practice Address - Fax:281-420-9604
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0864207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82684ZOtherBLUE CROSS BLUE SHIELD
TX84548ZOtherRENAISSANCE
TX160046845OtherMEDICARE RAILROAD
TX096543602Medicaid
TX28287OtherAMERIGROUP
TX160046845OtherMEDICARE RAILROAD
TX096543602Medicaid