Individual
RAKESH R SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
333 N 1ST ST STE 250, BOISE, ID 83702-6132
(208) 381-9384
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
MD210225
OR
2085R0202X
Diagnostic Radiology Physician
5145
WI
2085R0202X
Diagnostic Radiology Physician
J2321
TX
2085R0202X
Diagnostic Radiology Physician
MC-1523
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100155790A
—
OK
05
—
103357301
—
TX
01
—
123729100
FIRSTCARE
—
01
—
82R448
BLUE CROSS
TX
01
—
MDJ2321
WORKERS COMPENSATION
TX
05
—
Q3953
—
NM
Enumeration date
04/03/2006
Last updated
05/15/2025
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