Basic Information
Provider Information
NPI: 1184911448
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHAH
FirstName: JAMIL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 909 FROSTWOOD DR STE 1.100
Address2:  
City: HOUSTON
State: TX
PostalCode: 770242301
CountryCode: US
TelephoneNumber: 7133386353
FaxNumber: 7137043086
Practice Location
Address1: 921 GESSNER RD FL 8
Address2:  
City: HOUSTON
State: TX
PostalCode: 770242501
CountryCode: US
TelephoneNumber: 7132423768
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/06/2011
LastUpdateDate: 05/15/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/15/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XQ0822TXN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000XQ0822TXY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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