Provider Demographics
NPI:1114966470
Name:SHAH, DIPAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DIPAN
Middle Name:
Last Name:SHAH
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 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1901
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-1100
Mailing Address - Fax:713-790-2643
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1901
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-1100
Practice Address - Fax:713-790-2643
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35856207RC0000X
TXM8990207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197597104Medicaid
TXP01309355OtherRR MEDICARE
LA1886513Medicaid
TX197597103Medicaid
TXP00639774OtherRAILROAD MEDICARE
TX197597101Medicaid
TX197597102Medicaid
TXP01037137OtherRR MEDICARE
TX8AH673OtherBC/BS
TX339224YMVQMedicare PIN
TXP01309355OtherRR MEDICARE
LA1886513Medicaid
TXP00639774OtherRAILROAD MEDICARE
TX197597104Medicaid