Provider Demographics
NPI:1679597686
Name:SHAH, BAKHTIAR (MD)
Entity Type:Individual
Prefix:DR
First Name:BAKHTIAR
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 1:4955 BELLCHASE DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7764
Mailing Address - Country:US
Mailing Address - Phone:516-849-2385
Mailing Address - Fax:979-730-3125
Practice Address - Street 1:77 SUGAR CREEK CENTER BLVD STE 375
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3789
Practice Address - Country:US
Practice Address - Phone:516-849-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2736207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0P9252Medicare ID - Type Unspecified
NY07061GMedicare ID - Type UnspecifiedGHI/MEDICARE
F70270Medicare UPIN