Provider Demographics
NPI:1679571004
Name:SUNDARAM, EASWAR M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EASWAR
Middle Name:M
Last Name:SUNDARAM
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:321 N HIGHLAND AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7378
Mailing Address - Country:US
Mailing Address - Phone:903-893-5141
Mailing Address - Fax:903-893-5891
Practice Address - Street 1:321 N HIGHLAND AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7378
Practice Address - Country:US
Practice Address - Phone:903-893-5141
Practice Address - Fax:903-893-5891
Is Sole Proprietor?:No
Enumeration Date:2005-07-10
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH56372084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100153100Medicaid
TX83Z011OtherBLUE CROSS
TX130004886OtherRAILROAD MEDICARE
TX114132703Medicaid
TX114132703Medicaid
TXE29340Medicare UPIN