Provider Demographics
NPI:1932268273
Name:SHAH, AMBER M (MD)
Entity Type:Individual
Prefix:MR
First Name:AMBER
Middle Name:M
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 37388
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71133-7388
Mailing Address - Country:US
Mailing Address - Phone:318-797-2328
Mailing Address - Fax:318-524-1380
Practice Address - Street 1:8001 YOUREE DRIVE
Practice Address - Street 2:740
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115
Practice Address - Country:US
Practice Address - Phone:318-797-2328
Practice Address - Fax:318-797-2328
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41146207R00000X
LA203695207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4P101D252Medicare PIN