Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | ME53099 | FL |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | ME53099 | FL |
NPI | 1477515302 |
---|---|
Provider Name | Mohan M Shah |
First Address | Lakeland, FL 33815-4600 |
Second Address | Lakeland, FL 33815-4600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E22432 | (02) | FL |