Healthcare Provider Details

I. General information

NPI: 1881660538
Provider Name (Legal Business Name): UDAY T.R. SHANKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DR STE 3N
HAZARD KY
41701-9478
US

IV. Provider business mailing address

200 MEDICAL CENTER DR SUITE 2B
HAZARD KY
41701-9466
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-6779
  • Fax:
Mailing address:
  • Phone: 606-439-3952
  • Fax: 606-439-0154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number27169
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: