Provider Demographics
NPI:1831372606
Name:GIRA S. SHAH, MD, PA
Entity type:Organization
Organization Name:GIRA S. SHAH, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GIRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-726-7800
Mailing Address - Street 1:203 S. SEMINOLE AVE.
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452
Mailing Address - Country:US
Mailing Address - Phone:352-726-7800
Mailing Address - Fax:352-726-8300
Practice Address - Street 1:203 S. SEMINOLE AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452
Practice Address - Country:US
Practice Address - Phone:352-726-7800
Practice Address - Fax:352-726-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71583207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00061384OtherRAIL ROAD MEDICARE
P00061384OtherRAILROAD MEDICARE
FL32187OtherBLUE CROSS BLUE SHIELD
FL268959600Medicaid
FLP00061384OtherRAIL ROAD MEDICARE
FL268959600Medicaid