MEDICARE: DR. ANJAN SHAH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	L9472	TX
2	2080P0202X	Pediatric Cardiology Physician	L9472	TX
3	207R00000X	Internal Medicine Physician	26462	OK
4	208000000X	Pediatrics Physician	26462	OK
5	2080P0202X	Pediatric Cardiology Physician	26462	OK

General Provider Information

NPI Number	:	1609847680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANJAN SHAH M.D.

Provider Business Mailing Address
First Line	:	1200 EVERETT DR
Second Line	:	NP2350
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5047
Country	:	US
Telephone Number	:	405-271-4411
Fax Number	:	405-271-5055

Provider Business Practice Location Address
First Line	:	1200 N PHILLIPS AVE
Second Line	:	SUITE 3900
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-4600
Country	:	US
Telephone Number	:	405-271-5530
Fax Number	:	405-271-5055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/01/2015

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