Provider Demographics
NPI:1164569182
Name:SHAH, MANJUL (MD)
Entity Type:Individual
Prefix:
First Name:MANJUL
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:TRUXTUN RADIOLOGY MEDICAL GROUP LP
Mailing Address - Street 2:1817 TRUXTUN AVE
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301
Mailing Address - Country:US
Mailing Address - Phone:661-325-6800
Mailing Address - Fax:661-325-4734
Practice Address - Street 1:TRUXTUN RADIOLOGY MEDICAL GROUP LP
Practice Address - Street 2:1817 TRUXTUN AVE
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301
Practice Address - Country:US
Practice Address - Phone:661-325-6800
Practice Address - Fax:661-325-4734
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2015-02-17
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Provider Licenses
StateLicense IDTaxonomies
CAA496572085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A82401Medicare UPIN