Basic Information
| Provider Information | |||||||||
| NPI: | 1790758308 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | VIPUL | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29441 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782290441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106167700 | ||||||||
| FaxNumber: | 2106167709 | ||||||||
| Practice Location | |||||||||
| Address1: | 8401 DATAPOINT DR STE 600 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782295907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106167700 | ||||||||
| FaxNumber: | 2106167709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 03/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35084332 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD420768 | PA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 22966 | WV | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 4301091002 | MI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 2007-01223 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 30357 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | ME-111218 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 01071379 | IN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | P5471 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 3500837-01 | 05 | TX | MEDICAID | P5471 | 01 | TX | TEXAS MEDICAL LICENSE | OTHER | P01516838 | 01 | TX | RAILROAD MEDICARE | OTHER | 3500837-02 | 05 | TX | MEDICAID | 3500837-03 | 05 | TX | MEDICAID | P01516466 | 01 | TX | RAILROAD MEDICARE | OTHER |