1013910108 NPI number — DR. JOSEPH D KHOURY MD

Table of content: DR. JOSEPH D KHOURY MD (NPI 1013910108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013910108 NPI number — DR. JOSEPH D KHOURY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHOURY
Provider First Name:
JOSEPH
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013910108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4439
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77210-4439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-792-2991
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 HOLCOMBE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-4009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-792-6161
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  12025 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 37611 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: P1660 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104677769 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2523308 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 351017839A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64079866 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009951825 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0585265 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 152669001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209140508 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7615208 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200026870A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 422400000 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5440416 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200376220A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 293283201 (MDACC) , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200476640A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q37611 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0059269 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09559099 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82578600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8DE741 . This is a "BCBS (MDACC)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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