Provider Demographics
NPI:1477591709
Name:SHAPIRO, HENRY J (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:J
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING AND RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:431 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3103
Practice Address - Country:US
Practice Address - Phone:561-748-2488
Practice Address - Fax:561-748-2468
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33108174400000X
FLME33041207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL530622OtherWELLCARE
FL312299OtherAVMED
FL7609OtherDIMENSION HEALTH PPO
FL039739300Medicaid
FL95378OtherBCBS
FLP1035623OtherFREEDOM
FLP971393OtherOPTIMUM
FL4534766OtherAETNA
FLP01582234OtherRR MEDICARE
FL530622OtherWELLCARE
FL7609OtherDIMENSION HEALTH PPO
FLP971393OtherOPTIMUM