Provider Demographics
NPI:1821677741
Name:SHAH, JAMIE JATIN (DO)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:JATIN
Last Name:SHAH
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-ZPL-A
Mailing Address - Street 2:3551 ROGER BROOKE DR.
Mailing Address - City:JBSA-FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-6807
Mailing Address - Fax:210-916-4530
Practice Address - Street 1:SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-ZPL-A
Practice Address - Street 2:3551 ROGER BROOKE DR.
Practice Address - City:JBSA-FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-6807
Practice Address - Fax:210-916-4530
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2023-08-11
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102207686208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice