Provider Demographics
NPI:1780944496
Name:KHAN, SAMAD (MD)
Entity type:Individual
Prefix:
First Name:SAMAD
Middle Name:
Last Name:KHAN
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 1:4300 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4304
Mailing Address - Country:US
Mailing Address - Phone:585-978-0796
Mailing Address - Fax:
Practice Address - Street 1:4040 LEGACY DR STE 204
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6748
Practice Address - Country:US
Practice Address - Phone:469-331-0111
Practice Address - Fax:469-250-2023
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6046207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine