Individual
DR. SANJIV A SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
124 S MEMORIAL DR, PRATTVILLE, AL 36067-3619
(334) 613-3680
(334) 613-3685
Mailing address
4371 NARROW LANE RD, SUITE 100, MONTGOMERY, AL 36116-2971
(334) 613-3680
(334) 613-3685
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
00026760
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009932223
—
AL
01
—
051002492
BLUE CROSS BLUE SHIELD
—
Enumeration date
03/09/2006
Last updated
02/18/2010
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