Healthcare Provider Details

I. General information

NPI: 1043476476
Provider Name (Legal Business Name): RAJAL DHRUVISH SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR SUITE 300
AUSTIN TX
78758-5387
US

IV. Provider business mailing address

2200 PARK BEND DR SUITE 300
AUSTIN TX
78758-5387
US

V. Phone/Fax

Practice location:
  • Phone: 512-836-5665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP9956
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0067922
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: