Individual
DR. GOUTAM PADA SHOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9812 SLIDE RD, LUBBOCK, TX 79424-5781
(806) 725-8420
(806) 783-9059
Mailing address
3420 22ND PL, LUBBOCK, TX 79410-1314
(806) 725-5844
(806) 723-6532
Taxonomy
Speciality
Code
Description
License number
State
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
Primary
L3825
TX
207RR0500X
Rheumatology Physician
L3825
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143911903
—
TX
01
—
P00671980
RAILROAD MEDICARE
TX
Enumeration date
10/20/2005
Last updated
02/06/2013
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