Provider Demographics
NPI:1962661090
Name:SHAH, KRISTIN BROZENA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:BROZENA
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:502 MADISON OAK DR
Mailing Address - Street 2:SUITE 440
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4084
Mailing Address - Country:US
Mailing Address - Phone:210-946-1300
Mailing Address - Fax:
Practice Address - Street 1:502 MADISON OAK DR
Practice Address - Street 2:SUITE 440
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4084
Practice Address - Country:US
Practice Address - Phone:210-946-1300
Practice Address - Fax:210-946-1700
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP2203207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX303124701Medicaid