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General NPI Number Information
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NPI Number | 1215265616
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Entity Type | Organization
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Legal Business Name | SHAM S. GANDHI PHD MD PA
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Dates
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Enumeration Date | 11/23/2009
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 3602 23RD ST
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City | LUBBOCK
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State | TX
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Zip | 79410-1326
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Country | US
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Telephone | 806-792-2757
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Fax | 806-792-0206
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Provider Business Mailing Address
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Address Line | 3602 23RD ST
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City | LUBBOCK
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State | TX
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Zip | 79410-1326
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Country | US
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Telephone | 806-792-2757
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Fax | 806-792-0206
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. SHAM SUNDER GANDHI
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Credential | PHD MD
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Telephone | 806-792-2757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MDF1561
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License Number State | TX
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