Provider Demographics
NPI:1831385012
Name:JAYRAJ C. SHAH, MD,PC
Entity type:Organization
Organization Name:JAYRAJ C. SHAH, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:JAYRAJ
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-762-8588
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0508
Mailing Address - Country:US
Mailing Address - Phone:931-762-8588
Mailing Address - Fax:931-766-1010
Practice Address - Street 1:416 N LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3518
Practice Address - Country:US
Practice Address - Phone:931-762-8588
Practice Address - Fax:931-766-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12977207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3383582Medicaid
TN3182622Medicaid
TN3182622Medicaid
TN3383582Medicaid