Healthcare Provider Details

I. General information

NPI: 1356607956
Provider Name (Legal Business Name): BALRAM JONATHAN SHARMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12319 N MOPAC EXPY
AUSTIN TX
78758-2414
US

IV. Provider business mailing address

600 JEFFERSON ST STE 600
LAFAYETTE LA
70501-6987
US

V. Phone/Fax

Practice location:
  • Phone: 512-835-5577
  • Fax:
Mailing address:
  • Phone: 337-202-0720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberU4009
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: