Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | N7347 | TX |
N | 207QG0300X | Family Doctor - Geriatric Medicine | N7347 | TX |
NPI | 1053373001 |
---|---|
Provider Name | Dr. Ami R Shah |
First Address | Plano, TX 75093-8124 |
Second Address | Plano, TX 75093-8124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 20/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H75777 | (02) | |
N7347 | STATE LICENSE (01) | TX |