Provider Demographics
NPI:1801907779
Name:SHAH, HEERAL R (MD)
Entity type:Individual
Prefix:DR
First Name:HEERAL
Middle Name:R
Last Name:SHAH
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1703 W 30TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1625
Mailing Address - Country:US
Mailing Address - Phone:417-781-2616
Mailing Address - Fax:417-781-2934
Practice Address - Street 1:1703 W 30TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1625
Practice Address - Country:US
Practice Address - Phone:417-781-2616
Practice Address - Fax:417-781-2934
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-09-09
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Provider Licenses
StateLicense IDTaxonomies
MO2010013508207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFK976ZMedicare UPIN
FL14F4NOtherBLUE CROSS AND BLUE SHIELD