MEDICARE: DR. MORTEZA SHAHMIR 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
1	207RG0100X	Gastroenterology Physician	20065	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1389436	OTHER		ECFMG
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699778506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MORTEZA SHAHMIR M.D.

Provider Business Mailing Address
First Line	:	1211 WOODHURST ST
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42104-3368
Country	:	US
Telephone Number	:	270-782-7373
Fax Number	:	270-796-8676

Provider Business Practice Location Address
First Line	:	1211 WOODHURST ST
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42104-3368
Country	:	US
Telephone Number	:	270-782-7373
Fax Number	:	270-796-8676

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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