Provider Demographics
NPI:1205903077
Name:SHAH, ANAND GOPAL (MD)
Entity type:Individual
Prefix:
First Name:ANAND
Middle Name:GOPAL
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 1:18838 STONE OAK PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4179
Mailing Address - Country:US
Mailing Address - Phone:210-833-7972
Mailing Address - Fax:210-745-2971
Practice Address - Street 1:18838 STONE OAK PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4179
Practice Address - Country:US
Practice Address - Phone:210-833-7972
Practice Address - Fax:210-745-2971
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241809207Y00000X
CAA91455207YX0007X
TXM8988207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L22241Medicare PIN