Individual
BOBBY AJAY SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3275 SW DARWIN BLVD, PORT ST LUCIE, FL 34953-3317
(800) 437-2672
Mailing address
825 E LINCOLNWAY, VALPARAISO, IN 46383-5803
(219) 464-4891
(219) 464-1873
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01056041A
IN
2085R0204X
Vascular & Interventional Radiology Physician
01056041A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200382730
—
IN
01
—
300135676
RR MEDICARE
IN
Enumeration date
06/09/2006
Last updated
01/16/2023
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