Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | M8994 | TX |
Y | 2080P0202X | Pediatric Cardiologist | M8994 | TX |
NPI | 1154322162 |
---|---|
Provider Name | Dr. Tejas K Shah |
First Address | Dallas, TX 75230-6816 |
Second Address | Dallas, TX 75230-6816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1154322162 | (05) | WI |
I31110 | (02) | TN |