Provider Demographics
NPI:1962491191
Name:SHOME, GOUTAM PADA (MD)
Entity Type:Individual
Prefix:DR
First Name:GOUTAM
Middle Name:PADA
Last Name:SHOME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3420 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1314
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:9812 SLIDE RD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-5781
Practice Address - Country:US
Practice Address - Phone:806-725-8420
Practice Address - Fax:806-783-9059
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL3825207RA0201X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00671980OtherRAILROAD MEDICARE
TX143911903Medicaid
TXG14193Medicare UPIN
TX8J4528Medicare PIN