Basic Information
Provider Information | |||||||||
NPI: | 1710273685 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KHALID | ||||||||
FirstName: | FATIMA | ||||||||
MiddleName: | RIZWAN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1420 VICEROY DR | ||||||||
Address2: |   | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752352208 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2143582300 | ||||||||
FaxNumber: | 2143666159 | ||||||||
Practice Location | |||||||||
Address1: | 411 N WASHINGTON AVE STE 7000 | ||||||||
Address2: |   | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752461791 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2143582300 | ||||||||
FaxNumber: | 2145796988 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/20/2011 | ||||||||
LastUpdateDate: | 01/07/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/07/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | E-11330 | AR | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 2016035218 | MO | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | R8924 | TX | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
ID | Type | State | Issuer | Description | R8924 | 01 | TX | TEXAS LICENSE | OTHER |