Healthcare Provider Details

I. General information

NPI: 1184841603
Provider Name (Legal Business Name): VINOD PRASAD MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E TAYLOR ST SUITE 103
SHERMAN TX
75090-2881
US

IV. Provider business mailing address

600 E TAYLOR ST SUITE 103
SHERMAN TX
75090-2881
US

V. Phone/Fax

Practice location:
  • Phone: 903-893-7170
  • Fax: 903-893-4372
Mailing address:
  • Phone: 903-893-7170
  • Fax: 903-893-4372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME98208
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number31742
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberQ3576
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: