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NPI Code Detail

MEDICARE: DR. ANIL SHAH M.D.

MEDICARE: DR. ANIL SHAH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianMD25450OR
2208M00000XHospitalist PhysicianMD25450OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629047212
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANIL SHAH M.D.
Provider Business Mailing Address
First Line : 19300 SW 65TH AVE
Second Line :
City : TUALATIN
State : OR
Zip : 97062-7706
Country : US
Telephone Number : 503-692-2439
Fax Number :
Provider Business Practice Location Address
First Line : 19300 SW 65TH AVE
Second Line :
City : TUALATIN
State : OR
Zip : 97062-7706
Country : US
Telephone Number : 503-692-2439
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 07/16/2007

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Directions to “ DR. ANIL SHAH M.D.” Practice Location

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