Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | MD39642 | TN |
NPI | 1013936079 |
---|---|
Provider Name | Jigar Kanubhai Shah |
First Address | Clarksville, TN 37043-5442 |
Second Address | Clarksville, TN 37043-5653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 17/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33358601 | (05) | TN |
4119802 | BLUE CROSS (01) | TN |
I47014 | (02) |