Provider Demographics
NPI:1063550291
Name:SHAH, JIGNESH PRAVIN (MD)
Entity type:Individual
Prefix:DR
First Name:JIGNESH
Middle Name:PRAVIN
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1403 BLAKELY GROVE LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-3553
Mailing Address - Country:US
Mailing Address - Phone:732-423-0151
Mailing Address - Fax:267-508-9575
Practice Address - Street 1:444 FM 1959 RD
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-5416
Practice Address - Country:US
Practice Address - Phone:281-481-9400
Practice Address - Fax:281-464-8528
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40668207R00000X, 207RG0100X, 208000000X
IN01061189AP207R00000X, 208000000X
TXN5389207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics