Healthcare Provider Details

I. General information

NPI: 1548551427
Provider Name (Legal Business Name): PRAMOD SHARMA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL DR
BORGER TX
79007-7579
US

IV. Provider business mailing address

1509 PELLINORE ST
BORGER TX
79007-6342
US

V. Phone/Fax

Practice location:
  • Phone: 806-467-5702
  • Fax:
Mailing address:
  • Phone: 972-408-8154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP9254
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberP9254
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberP9254
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: