Individual
FATIMA S SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
315 SE STONE MILL DR, SUITE 102, VANCOUVER, WA 98684-6998
(360) 816-2700
(360) 816-2710
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP00002144
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0214145
LABOR & IND. WA STATE
WA
05
—
200334350
—
IN
05
—
240360
—
OR
05
—
8465619
—
WA
01
—
8942796
CRIME VICTIMS WA STATE
WA
01
—
P00822615
RR MEDICARE
WA
Enumeration date
07/08/2005
Last updated
07/27/2012
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