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General NPI Number Information
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NPI Number | 1275745465
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Entity Type | Organization
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Legal Business Name | JAGDISH A. SHAH,MD
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2010
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Provider Practice Location Address
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Address Line | 1220 EAST 6TH STREET
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City | BONHAM
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State | TX
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Zip | 75418
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Country | US
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Telephone | 903-583-7424
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Fax | 903-583-0442
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Provider Business Mailing Address
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Address Line | 1220 E 6TH ST
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City | BONHAM
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State | TX
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Zip | 75418-4017
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Country | US
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Telephone | 903-583-7424
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Fax | 903-583-0442
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Authorized Official
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Title or Position | OWNER
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Name | JAGDISH AMRATLAL SHAH
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Credential | M.D.
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Telephone | 903-583-7424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J2792
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License Number State | TX
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