Provider Demographics
NPI:1992915284
Name:ASHVIN K. SHAH, M.D., PC
Entity type:Organization
Organization Name:ASHVIN K. SHAH, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-344-1891
Mailing Address - Street 1:2110 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8878
Mailing Address - Country:US
Mailing Address - Phone:928-344-1891
Mailing Address - Fax:928-726-6306
Practice Address - Street 1:2110 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8878
Practice Address - Country:US
Practice Address - Phone:928-344-1891
Practice Address - Fax:928-726-6306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14383207RP1001X
AZ36398207RP1001X
207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1790976108OtherBLANCA E HUERTA, PA PERSONAL NPI
AZ1518016096OtherDR LESSER NPI
AZ1013015270OtherDR SHAH PERSONAL NPI
AZ637009Medicaid
AZ1790976108OtherBLANCA E HUERTA, PA PERSONAL NPI
AZ637009Medicaid