Individual
PURVIN SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
9802 BAYMEADOWS RD STE 12, PMB # 156, JACKSONVILLE, FL 32256-7987
(904) 435-7993
Mailing address
9802 BAYMEADOWS RD STE 12, PMB # 156, JACKSONVILLE, FL 32256-7987
(904) 435-7993
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
OS10029
FL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
OS10029
FL
207RP1001X
Pulmonary Disease Physician
Primary
OS10029
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278367300
—
FL
01
—
30149
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/11/2005
Last updated
12/13/2014
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