Provider Demographics
NPI:1972502383
Name:SHAH, GAURAV K (MD)
Entity Type:Individual
Prefix:DR
First Name:GAURAV
Middle Name:K
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2201 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1870
Mailing Address - Country:US
Mailing Address - Phone:314-367-1181
Mailing Address - Fax:314-968-5117
Practice Address - Street 1:1445 BUSH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5520
Practice Address - Country:US
Practice Address - Phone:415-972-4600
Practice Address - Fax:415-975-0999
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2023-08-30
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Provider Licenses
StateLicense IDTaxonomies
CAG186226207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G57603Medicare UPIN