Provider Demographics
NPI:1659481620
Name:SHADER, ALAN FRED (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:FRED
Last Name:SHADER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7793
Mailing Address - Country:US
Mailing Address - Phone:305-681-2600
Mailing Address - Fax:305-685-0906
Practice Address - Street 1:3800 WEST 12TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:305-681-2600
Practice Address - Fax:305-685-5098
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO001468213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000141973Medicaid
COP01770676OtherRAILROAD MEDICARE
FL0410985000Medicaid
COP01770676OtherRAILROAD MEDICARE
CO9000141973Medicaid
FL0735420001Medicare NSC
CO549456ZSGHMedicare PIN