Provider Demographics
NPI:1508855883
Name:PRABHAKAR, SHARMA S (MD)
Entity Type:Individual
Prefix:
First Name:SHARMA
Middle Name:S
Last Name:PRABHAKAR
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 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-3150
Mailing Address - Fax:806-743-3168
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-9410
Practice Address - Country:US
Practice Address - Phone:806-743-3150
Practice Address - Fax:806-743-3168
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7082207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS8208Medicaid
TX048538501Medicaid
NM52507Medicaid
TX121752101OtherFIRSTCARE COMMERCIAL
TX82842ZOtherHMO BLUE
TX84260SOtherBC/BS
OK100153390AMedicaid
NMA250OtherTRIWEST
NM52507OtherPRESBYTERIAN COMMERCIAL
TX044190901OtherTMHP
TX121752100Medicaid
OK100153390AMedicaid
TX044190901OtherTMHP
NM52507OtherPRESBYTERIAN COMMERCIAL