Provider Demographics
NPI:1447270095
Name:SHROFF, MANISH (MD)
Entity type:Individual
Prefix:DR
First Name:MANISH
Middle Name:
Last Name:SHROFF
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:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79721-0150
Mailing Address - Country:US
Mailing Address - Phone:432-267-9805
Mailing Address - Fax:432-264-7542
Practice Address - Street 1:1501 W 11TH PL
Practice Address - Street 2:301
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-4121
Practice Address - Country:US
Practice Address - Phone:432-267-9805
Practice Address - Fax:432-264-7542
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5063207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137375512Medicaid
TX137375512Medicaid
TXTXB108199Medicare PIN