Provider Demographics
NPI:1629061403
Name:SHAPIRO, HERBERT NORMAN (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:NORMAN
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 1:617 BROOKMONT LAKE CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7059
Mailing Address - Country:US
Mailing Address - Phone:314-845-2500
Mailing Address - Fax:314-845-8060
Practice Address - Street 1:6150 OAKLAND AVE
Practice Address - Street 2:2ND FLOOR, WCC
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-3215
Practice Address - Country:US
Practice Address - Phone:314-845-2500
Practice Address - Fax:314-845-8060
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO27603208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200989705Medicaid
A26764Medicare UPIN
MO200989705Medicaid