MEDICARE: MR. BALRAM JONATHAN SHARMA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	U4009	TX

General Provider Information

NPI Number	:	1356607956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BALRAM JONATHAN SHARMA MD

Provider Business Mailing Address
First Line	:	600 JEFFERSON ST STE 600
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-6987
Country	:	US
Telephone Number	:	337-202-0720
Fax Number	:

Provider Business Practice Location Address
First Line	:	12319 N MOPAC EXPY
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-2414
Country	:	US
Telephone Number	:	512-835-5577
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2012
Last Update Date	:	08/14/2023

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