Provider Demographics
NPI:1912189747
Name:SHARDA J. DOSHI, M.D.PA
Entity Type:Organization
Organization Name:SHARDA J. DOSHI, M.D.PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARDA
Authorized Official - Middle Name:JITENDRA
Authorized Official - Last Name:DOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-833-8850
Mailing Address - Street 1:2929 CALDER AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1845
Mailing Address - Country:US
Mailing Address - Phone:409-833-8850
Mailing Address - Fax:409-833-2829
Practice Address - Street 1:2929 CALDER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1845
Practice Address - Country:US
Practice Address - Phone:409-833-8850
Practice Address - Fax:409-833-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0692208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00B17YOtherBLUE CROSS BLUE SHIELD
TX132971602Medicaid
TX00B17YOtherBLUE CROSS BLUE SHIELD