Provider Demographics
NPI:1962727453
Name:SHAH, GAURAV S (MD)
Entity type:Individual
Prefix:DR
First Name:GAURAV
Middle Name:S
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 1:5616 W NORVELL BRYANT HWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-7572
Mailing Address - Country:US
Mailing Address - Phone:352-795-1999
Mailing Address - Fax:352-795-2269
Practice Address - Street 1:5616 W NORVELL BRYANT HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-7572
Practice Address - Country:US
Practice Address - Phone:352-795-1999
Practice Address - Fax:352-795-2269
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126363207RC0200X, 207RP1001X, 207RC0200X
TN50464390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I114385Medicare PIN
TN103I110564Medicare PIN