Healthcare Provider Details

I. General information

NPI: 1992861074
Provider Name (Legal Business Name): CLEBURNE PEDIATRICS P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2006
Last Update Date: 04/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 RIDGEWAY DRIVE NORTH
CLEBURNE TX
76033
US

IV. Provider business mailing address

215 RIDGEWAY DRIVE NORTH
CLEBURNE TX
76033
US

V. Phone/Fax

Practice location:
  • Phone: 817-774-2560
  • Fax: 817-774-2563
Mailing address:
  • Phone: 817-774-2560
  • Fax: 817-774-2563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ2324
License Number StateTX

VIII. Authorized Official

Name: DR. RANBIR K SHARMA
Title or Position: PRESIDENT
Credential: MD
Phone: 817-774-2560