Healthcare Provider Details

I. General information

NPI: 1033775168
Provider Name (Legal Business Name): JIVESH SHARMA M.D. PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12606 GREENVILLE AVE STE 185
DALLAS TX
75243-1921
US

IV. Provider business mailing address

6119 GREENVILLE AVE # 425
DALLAS TX
75206-1910
US

V. Phone/Fax

Practice location:
  • Phone: 214-707-3759
  • Fax:
Mailing address:
  • Phone: 214-707-3759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JIVESH SHARMA
Title or Position: PHYSICIAN OWNER
Credential:
Phone: 214-707-3759