Provider Demographics
NPI:1033469028
Name:GILBERT D SHAPIRO, DPM PC
Entity Type:Organization
Organization Name:GILBERT D SHAPIRO, DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:520-327-6367
Mailing Address - Street 1:1888 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3115
Mailing Address - Country:US
Mailing Address - Phone:520-327-6367
Mailing Address - Fax:520-318-4492
Practice Address - Street 1:1888 N COUNTRY CLUB RD.
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3115
Practice Address - Country:US
Practice Address - Phone:520-327-6367
Practice Address - Fax:520-318-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0173213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ701111Medicaid
AZ1255860001Medicare NSC
AZ701111Medicaid