Provider Demographics
NPI:1790066355
Name:MYRON S SHAPERO MD INC
Entity Type:Organization
Organization Name:MYRON S SHAPERO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-273-7365
Mailing Address - Street 1:PO BOX 67307
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-0307
Mailing Address - Country:US
Mailing Address - Phone:310-273-7365
Mailing Address - Fax:310-273-7366
Practice Address - Street 1:99 N LA CIENEGA BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2222
Practice Address - Country:US
Practice Address - Phone:310-360-1047
Practice Address - Fax:310-659-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty