Provider Demographics
NPI:1538240031
Name:SHAH, BHAVESH J (DPM)
Entity type:Individual
Prefix:DR
First Name:BHAVESH
Middle Name:J
Last Name:SHAH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40055
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-1055
Mailing Address - Country:US
Mailing Address - Phone:210-928-3668
Mailing Address - Fax:210-572-9290
Practice Address - Street 1:7333 BARLITE BLVD
Practice Address - Street 2:SUITE 380
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1320
Practice Address - Country:US
Practice Address - Phone:210-928-3668
Practice Address - Fax:210-572-9290
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1503213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8609968-01Medicaid
TXU93652Medicare UPIN
8A8620Medicare PIN