Provider Demographics
NPI:1497834816
Name:SHAH, JAGDISH AMRATLAL (MD)
Entity Type:Individual
Prefix:
First Name:JAGDISH
Middle Name:AMRATLAL
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:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-0158
Mailing Address - Country:US
Mailing Address - Phone:903-583-7424
Mailing Address - Fax:903-583-0442
Practice Address - Street 1:1220 E 6TH ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4017
Practice Address - Country:US
Practice Address - Phone:903-583-7424
Practice Address - Fax:903-583-0442
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF38359Medicare UPIN
TX89430KMedicare ID - Type Unspecified