Provider Demographics
NPI:1013010099
Name:SHORI, PARDEEP K (DO)
Entity Type:Individual
Prefix:
First Name:PARDEEP
Middle Name:K
Last Name:SHORI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7012 LA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-4042
Mailing Address - Country:US
Mailing Address - Phone:817-564-5761
Mailing Address - Fax:
Practice Address - Street 1:7012 LA VISTA DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214
Practice Address - Country:US
Practice Address - Phone:817-564-5761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03400207Q00000X
MN63740207Q00000X
WI56069207Q00000X
NJ25MB09130600207Q00000X
CA11695207Q00000X
TXM3736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199360201Medicaid
TX199360202Medicaid
TX8BQ003OtherBCBS
TX199360203Medicaid
TX199360204Medicaid
TXP00680235OtherRAILROAD MEDICARE
TX199360203Medicaid
TX199360201Medicaid
TXP00680235OtherRAILROAD MEDICARE
TXTXB101944Medicare PIN
TX8L6856Medicare PIN