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General NPI Number Information
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NPI Number | 1417299413
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Entity Type | Individual
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Provider Name | SHOBHIT JAIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/18/2013
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 4100 W UNIVERSITY DR
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City | PROSPER
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State | TX
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Zip | 75078-3123
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Country | US
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Telephone | 945-204-4100
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Fax | 682-885-1903
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Provider Business Mailing Address
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Address Line | PO BOX 733784
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City | DALLAS
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State | TX
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Zip | 75373-3784
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Country | US
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Telephone | 682-885-6163
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Fax | 682-885-3113
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | 93138
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA09116900
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2014005003
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | V1953
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License Number State | TX
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