Provider Demographics
NPI:1013936079
Name:SHAH, JIGAR KANUBHAI (MD)
Entity Type:Individual
Prefix:
First Name:JIGAR
Middle Name:KANUBHAI
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 1:404 SAVANNAH TRACE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5442
Mailing Address - Country:US
Mailing Address - Phone:931-802-8056
Mailing Address - Fax:931-802-8059
Practice Address - Street 1:274 CLEAR SKY CT
Practice Address - Street 2:CLARKSVILLE CANCER CARE
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5653
Practice Address - Country:US
Practice Address - Phone:931-802-8056
Practice Address - Fax:931-802-8059
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD39642207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN33358601Medicaid
TN4119802OtherBLUE CROSS
TN33358601Medicaid
TN4119802OtherBLUE CROSS