Provider Demographics
NPI:1477543569
Name:SHAPIRO, JEFFREY M (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1140 W LA VETA AVE
Mailing Address - Street 2:SUITE 615
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4223
Mailing Address - Country:US
Mailing Address - Phone:714-543-8555
Mailing Address - Fax:714-543-6555
Practice Address - Street 1:1140 W LA VETA AVE
Practice Address - Street 2:SUITE 615
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4223
Practice Address - Country:US
Practice Address - Phone:714-543-8555
Practice Address - Fax:714-543-6555
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2009-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG36478207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A46697Medicare UPIN