=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013988666
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMESH C SHAH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 612 NOLANA ST STE 330
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-3026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-630-2225
-----------------------------------------------------
Fax | 956-630-2275
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 720670
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-0670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-630-2225
-----------------------------------------------------
Fax | 956-630-2275
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | G6132
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------