Healthcare Provider Details

I. General information

NPI: 1760673958
Provider Name (Legal Business Name): BAIJU SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 FAWCETT AVE STE 100
TACOMA WA
98402-1900
US

IV. Provider business mailing address

PO BOX 1535
TACOMA WA
98401-1535
US

V. Phone/Fax

Practice location:
  • Phone: 253-761-4200
  • Fax: 253-761-4201
Mailing address:
  • Phone: 253-761-4200
  • Fax: 253-383-3553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD60511642
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD188735
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD188735
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD60511642
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: