Provider Demographics
NPI:1720575293
Name:SHAH, PRASUN PUSHKARRAY (MD)
Entity type:Individual
Prefix:
First Name:PRASUN
Middle Name:PUSHKARRAY
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9180 PINECROFT DR STE 401
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3899
Mailing Address - Country:US
Mailing Address - Phone:713-897-7621
Mailing Address - Fax:
Practice Address - Street 1:9180 PINECROFT DR STE 401
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3899
Practice Address - Country:US
Practice Address - Phone:713-897-7621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR6900OtherMEDICAL BOARD