Provider Demographics
NPI:1386070399
Name:ANAND G. SHAH, MD, PA
Entity type:Organization
Organization Name:ANAND G. SHAH, MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:GOPAL
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-833-7972
Mailing Address - Street 1:18838 STONE OAK PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4179
Mailing Address - Country:US
Mailing Address - Phone:210-833-7972
Mailing Address - Fax:210-745-2971
Practice Address - Street 1:18838 STONE OAK PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4113
Practice Address - Country:US
Practice Address - Phone:210-833-7972
Practice Address - Fax:210-745-2971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8988207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207808103Medicaid
TX8L22241Medicare PIN
TX207808103Medicaid