=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164829800
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARUNKUMAR J. SHAH MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2014
-----------------------------------------------------
Last Update Date | 11/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1035 VAULTED OAK ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77008-1297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-202-0820
-----------------------------------------------------
Fax | 888-600-4066
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 50023
-----------------------------------------------------
City | CORPUS CHRISTI
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78465-0023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-667-6568
-----------------------------------------------------
Fax | 888-600-4066
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DANIEL M. MOYA
-----------------------------------------------------
Credential | R. NCS T.
-----------------------------------------------------
Telephone | 281-667-6568
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204R00000X
-----------------------------------------------------
Taxonomy Name | Electrodiagnostic Medicine Physician
-----------------------------------------------------
License Number | F6323
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | F6323
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | F6323
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | F6323
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | F6323
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------