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General NPI Number Information
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NPI Number | 1134120603
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Entity Type | Individual
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Provider Name | RAMESH R. SHAH M.D., F.A.C.S.,
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | 1703 W 30TH ST SUITE B
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City | JOPLIN
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State | MO
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Zip | 64804-1603
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Country | US
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Telephone | 417-781-2616
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Fax | 417-781-2934
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Provider Business Mailing Address
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Address Line | 1703 W 30TH ST SUITE B
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City | JOPLIN
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State | MO
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Zip | 64804-1603
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Country | US
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Telephone | 417-781-2616
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Fax | 417-781-2934
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | R1-D43
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License Number State | MO
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