Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 15736 | TN |
N | 207RR0500X | Rheumatology | 19472 | GA |
NPI | 1023100914 |
---|---|
Provider Name | Dr. Indravadan Keshavlal Shah |
First Address | Chattanooga, TN 37404 |
Second Address | Chattanooga, TN 37404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 31/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00311627A | (05) | GA |
3-00910-5 | (05) | TN |
A 97342 | (02) | TN |