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General NPI Number Information
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NPI Number | 1831385012
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Entity Type | Organization
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Legal Business Name | JAYRAJ C. SHAH, MD,PC
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 06/11/2013
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Provider Practice Location Address
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Address Line | 416 N LOCUST AVE
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City | LAWRENCEBURG
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State | TN
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Zip | 38464-3518
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Country | US
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Telephone | 931-762-8588
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Fax | 931-766-1010
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Provider Business Mailing Address
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Address Line | PO BOX 508
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City | LAWRENCEBURG
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State | TN
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Zip | 38464-0508
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Country | US
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Telephone | 931-762-8588
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Fax | 931-766-1010
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Authorized Official
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Title or Position | OWNER/MD
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Name | JAYRAJ C. SHAH
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Credential | MD
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Telephone | 931-762-8588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number | 12977
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License Number State | TN
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