Provider Demographics
NPI:1972659241
Name:SHAH, WASEEM A (MD)
Entity Type:Individual
Prefix:DR
First Name:WASEEM
Middle Name:A
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 1:610 SHEPHERD WAY
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143
Mailing Address - Country:US
Mailing Address - Phone:501-268-6831
Mailing Address - Fax:501-279-2402
Practice Address - Street 1:610 SHEPHERD WAY
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143
Practice Address - Country:US
Practice Address - Phone:501-268-6831
Practice Address - Fax:501-279-2402
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N924OtherBCBS
AR167282001Medicaid
AR167282001Medicaid