MEDICARE: RAHMAN SHAH MD

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	207R00000X	Internal Medicine Physician	ME140805	FL
2	207RC0000X	Cardiovascular Disease Physician	ME140805	FL
3	207RC0000X	Cardiovascular Disease Physician	42984	TN
4	208M00000X	Hospitalist Physician	230336	MA
5	390200000X	Student in an Organized Health Care Education/Training Program	0116023378	VA
6	207RI0011X	Interventional Cardiology Physician	ME140805	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	043649	OTHER	CT	CONN PHYSICIAN LICENSE #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780632380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAHMAN SHAH MD

Provider Business Mailing Address
First Line	:	2202 STATE AVE STE 207
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4582
Country	:	US
Telephone Number	:	850-872-3939
Fax Number	:	850-872-3938

Provider Business Practice Location Address
First Line	:	2202 STATE AVE STE 207
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4582
Country	:	US
Telephone Number	:	850-872-3939
Fax Number	:	850-872-3938

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	01/26/2022

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Directions to “ RAHMAN SHAH MD” Practice Location

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