Provider Demographics
NPI:1407941297
Name:SHAH, HARSHAD G (MD,PA)
Entity Type:Individual
Prefix:
First Name:HARSHAD
Middle Name:G
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 ANDREWS HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4822
Mailing Address - Country:US
Mailing Address - Phone:432-686-2020
Mailing Address - Fax:432-570-0888
Practice Address - Street 1:4214 ANDREWS HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4822
Practice Address - Country:US
Practice Address - Phone:432-686-2020
Practice Address - Fax:432-570-0888
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7461207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128107304Medicaid
NMV3363OtherNEW MEXICO PROVIDER NUMBE
TXP00134398OtherRAILROAD MEDICARE
NMV3363OtherNEW MEXICO PROVIDER NUMBE
TXP00134398OtherRAILROAD MEDICARE