Healthcare Provider Details

I. General information

NPI: 1609847680
Provider Name (Legal Business Name): ANJAN SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N PHILLIPS AVE SUITE 3900
OKLAHOMA CITY OK
73104-4600
US

IV. Provider business mailing address

1200 EVERETT DR NP2350
OKLAHOMA CITY OK
73104-5047
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5530
  • Fax: 405-271-5055
Mailing address:
  • Phone: 405-271-4411
  • Fax: 405-271-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL9472
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberL9472
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26462
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26462
License Number StateOK
# 5
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number26462
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: