Basic Information
| Provider Information | |||||||||
| NPI: | 1730186644 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHOURY | ||||||||
| FirstName: | ANWAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 SAINT MARYS RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | JUNCTION CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664414228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852235555 | ||||||||
| FaxNumber: | 7852236611 | ||||||||
| Practice Location | |||||||||
| Address1: | 1110 SAINT MARYS RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | JUNCTION CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664414228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852235555 | ||||||||
| FaxNumber: | 7852236611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 03/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0426286 | KS | N | Other Service Providers | Specialist | 207V00000X | 0426286 | KS | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 100190530B | 05 | KS | MEDICAID |