Provider Demographics
NPI:1528230653
Name:SHAPIRO, EVAN R (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:R
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11020 RCA CENTER DR
Mailing Address - Street 2:SUITE 2014
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4277
Mailing Address - Country:US
Mailing Address - Phone:561-625-0700
Mailing Address - Fax:561-691-6025
Practice Address - Street 1:11020 RCA CENTER DR
Practice Address - Street 2:SUITE 2014
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4277
Practice Address - Country:US
Practice Address - Phone:561-625-0700
Practice Address - Fax:561-691-6025
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0063565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF51277Medicare UPIN