Provider Demographics
NPI:1346276557
Name:BELLUR, SHASHI (MD)
Entity Type:Individual
Prefix:MR
First Name:SHASHI
Middle Name:
Last Name:BELLUR
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 1:600 RIVER POINTE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304
Mailing Address - Country:US
Mailing Address - Phone:936-756-8484
Mailing Address - Fax:936-756-8465
Practice Address - Street 1:600 RIVER POINTE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-756-8484
Practice Address - Fax:936-756-8465
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2739207RI0011X
TXJ3739207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060038298OtherRAILROAD MEDICARE
TX100327903Medicaid
TX8A5919OtherBLUE CROSS BLUE SHIELD TX
TX8A5919OtherBLUE CROSS BLUE SHIELD TX
TX060038298OtherRAILROAD MEDICARE