Provider Demographics
NPI:1770795551
Name:SHAH, RONAK V (DO)
Entity type:Individual
Prefix:DR
First Name:RONAK
Middle Name:V
Last Name:SHAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:EWING HALL SUITE 2.012
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:EWING HALL SUITE 2.012
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-1110
Practice Address - Country:US
Practice Address - Phone:409-772-5845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2013-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7874207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN7874OtherSTATE LICENSURE
NJ25MB08238000OtherNJ LICENSE