Provider Demographics
NPI:1548377104
Name:SHAH, SAMIR C (MD)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:C
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 1:7047 66TH ST
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-4002
Mailing Address - Country:US
Mailing Address - Phone:727-545-8887
Mailing Address - Fax:727-544-5959
Practice Address - Street 1:700 TYRONE BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7127
Practice Address - Country:US
Practice Address - Phone:727-384-5959
Practice Address - Fax:727-381-7667
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110115907OtherRAILROAD MEDICARE INDIVID
FL269324100Medicaid
FLCC1712OtherRAILROAD MEDICARE
FLE12136Medicare UPIN
FL33974Medicare ID - Type Unspecified
33974BMedicare PIN
FL33974AMedicare PIN
FLCC1712OtherRAILROAD MEDICARE