Organization
FLAGSTAFF NEUROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PANNA SHAH MD (PHYSICCIAN OWNER)
(619) 403-1701
Entity
Organization
Contact information
Practice address
4275 EXECUTIVE SQ STE 200, LA JOLLA, CA 92037-1476
(619) 403-1701
Mailing address
618 N HUMPHREYS ST, FLAGSTAFF, AZ 86001-3024
(928) 774-2459
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
33297
AZ
Other
Enumeration date
02/27/2008
Last updated
08/21/2012
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