Provider Demographics
NPI:1083723639
Name:SHAPIRO, STEVEN C (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 WOODSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3447
Mailing Address - Country:US
Mailing Address - Phone:601-434-3938
Mailing Address - Fax:
Practice Address - Street 1:323 WOODSHIRE DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3447
Practice Address - Country:US
Practice Address - Phone:601-434-3938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15101207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1559005OtherAMERICAN ADMIN GROUP
MS070010683OtherRAILROAD MEDICARE
MS00117508Medicaid
MS202494OtherUNITED HEALTHCARE
MS070000073Medicare PIN
MS1559005OtherAMERICAN ADMIN GROUP