Provider Demographics
NPI:1316945470
Name:EVAN R. SHAPIRO, M.D., P.A.
Entity type:Organization
Organization Name:EVAN R. SHAPIRO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT OF P.A.
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-625-0700
Mailing Address - Street 1:600 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 200-B
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2778
Mailing Address - Country:US
Mailing Address - Phone:561-625-0700
Mailing Address - Fax:561-691-6025
Practice Address - Street 1:600 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 200-B
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2778
Practice Address - Country:US
Practice Address - Phone:561-625-0700
Practice Address - Fax:561-691-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F51277Medicare UPIN
18533BMedicare ID - Type Unspecified