Doctor Name: | BASIL SHAH |
NPI Number: | 1679684872 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 4301077845 |
Business Practice Address: | 1340 Broad Ave Suite 450 Gulfport, MS - 395012404 |
Business Phone Number: | 2288675006 |
Business Fax Number: | 2288675079 |
Mailing Address: | Po Box 1810, GULFPORT |
State: | MS |
Postal Code: | 395021810 |
Phone Number: | 2288675006 |
Fax Number: | 2288675079 |
NPI Enumeration Date: | 08/31/2006 |
NPI Last Update Date: | 07/31/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 4301077845 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |