Provider Demographics
NPI:1205834660
Name:DLIMA, SHANTA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANTA
Middle Name:
Last Name:DLIMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-2904
Mailing Address - Country:US
Mailing Address - Phone:979-244-4323
Mailing Address - Fax:979-244-4328
Practice Address - Street 1:740 12TH ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-2904
Practice Address - Country:US
Practice Address - Phone:979-244-4323
Practice Address - Fax:979-244-4328
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040145703Medicaid
TX612914Medicare PIN