Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME107485 | FL |
Y | 111NI0900X | Internist | ME107485 | FL |
N | 207SG0201X | Clinical Genetics (M.D.) | 2002014672 | MO |
N | 207SG0201X | Clinical Genetics (M.D.) | ME107485 | FL |
N | 208000000X | Pediatrician | 2002014672 | MO |
NPI | 1417966219 |
---|---|
Provider Name | Dr. Maulik Raj Shah |
First Address | Gainesville, FL 32607-7608 |
Second Address | Gainesville, FL 32607-7608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 15/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007181600 | (05) | FL |
205999006 | (05) | MO |
H70324 | (02) | FL |