Provider Demographics
NPI:1104091933
Name:SHAH, ANJAN R (MD)
Entity type:Individual
Prefix:
First Name:ANJAN
Middle Name:R
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13020 N TELECOM PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0925
Mailing Address - Country:US
Mailing Address - Phone:813-978-9700
Mailing Address - Fax:813-558-6186
Practice Address - Street 1:560 S LAKEWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5016
Practice Address - Country:US
Practice Address - Phone:813-978-9700
Practice Address - Fax:813-558-6434
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME100905207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL316383OtherAVMED
FL7794524OtherCIGNA
FL000065200Medicaid
FL9595150OtherAETNA
FL30332OtherBLUECROSS BLUESHIELD
FL9595150OtherAETNA