Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 1015048 | TX |
NPI | 1043259583 |
---|---|
Provider Name | Mr. Jiten Krishnakant Shah |
First Address | Duncanville, TX 75116-4619 |
Second Address | Duncanville, TX 75116-4619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 15/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1932229507 | NPI (01) | TX |