Individual
JAYESH B SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8811 VILLAGE DR, NORTHEAST BAPTIST WOUND HEALING CENTER, SAN ANTONIO, TX 78217-5415
(210) 297-2520
(210) 297-2539
Mailing address
PO BOX 780764, SAN ANTONIO, TX 78278-0764
(210) 289-5948
(210) 408-0117
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
K1057
TX
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
K1057
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00298U
PTAN
TX
05
—
1552127-02
—
TX
Enumeration date
08/11/2005
Last updated
02/23/2015
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