Provider Demographics
NPI:1164829800
Name:ARUNKUMAR J. SHAH MD PA
Entity type:Organization
Organization Name:ARUNKUMAR J. SHAH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOYA
Authorized Official - Suffix:
Authorized Official - Credentials:R NCS T
Authorized Official - Phone:281-667-6568
Mailing Address - Street 1:PO BOX 50023
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78465-0023
Mailing Address - Country:US
Mailing Address - Phone:281-667-6568
Mailing Address - Fax:888-600-4066
Practice Address - Street 1:1035 VAULTED OAK ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1297
Practice Address - Country:US
Practice Address - Phone:713-202-0820
Practice Address - Fax:888-600-4066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6323204R00000X, 207Q00000X, 207RG0100X, 208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133912905Medicaid
TX133912905Medicaid
TXTXB152917Medicare PIN