Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | BP10046758 | TX |
Y | 207QS0010X | Family Doctor - Sports Medicine | Q3437 | TX |
NPI | 1255775177 |
---|---|
Provider Name | Dr. Nish Shah |
First Address | Richmond, TX 77406-5830 |
Second Address | Richmond, TX 77406-5830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2013 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
374917801 | (05) | TX |
374917802 | (05) | TX |