Provider Demographics
NPI:1407852650
Name:VAHORA, SHIRAJ ADAMBHAI (MD)
Entity Type:Individual
Prefix:
First Name:SHIRAJ
Middle Name:ADAMBHAI
Last Name:VAHORA
Suffix:
Gender:M
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:PO BOX 16829
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79490-6829
Mailing Address - Country:US
Mailing Address - Phone:806-535-6688
Mailing Address - Fax:
Practice Address - Street 1:1901 N US HIGHWAY 87
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-0283
Practice Address - Country:US
Practice Address - Phone:432-267-8216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH18532084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB27210Medicare UPIN
TX8187M3Medicare ID - Type Unspecified