Provider Demographics
NPI:1083770515
Name:SHASHI JAIN GOEL MD PC INC
Entity Type:Organization
Organization Name:SHASHI JAIN GOEL MD PC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHASHI
Authorized Official - Middle Name:JAIN
Authorized Official - Last Name:GOEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-242-7500
Mailing Address - Street 1:2040 W BETHANY HOME RD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2445
Mailing Address - Country:US
Mailing Address - Phone:602-242-7500
Mailing Address - Fax:602-433-2644
Practice Address - Street 1:2040 W BETHANY HOME RD
Practice Address - Street 2:SUITE #105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2445
Practice Address - Country:US
Practice Address - Phone:602-242-7500
Practice Address - Fax:602-433-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24977207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ388026Medicaid
AZ388026Medicaid
AZF40314Medicare UPIN