Provider Demographics
NPI:1811282619
Name:GOVERDHANA, SHYAM (MD)
Entity type:Individual
Prefix:
First Name:SHYAM
Middle Name:
Last Name:GOVERDHANA
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 1:224 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-3808
Mailing Address - Country:US
Mailing Address - Phone:806-935-2551
Mailing Address - Fax:806-935-2458
Practice Address - Street 1:1405 E 1ST ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-3570
Practice Address - Country:US
Practice Address - Phone:806-935-2551
Practice Address - Fax:806-935-2458
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339900801Medicaid
TX00593KMedicare UPIN
TX372292YMVRMedicare Oscar/Certification