Provider Demographics
NPI:1790070084
Name:SHAPIRO, JOSEPH M
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 OZARK DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-7046
Mailing Address - Country:US
Mailing Address - Phone:405-816-3539
Mailing Address - Fax:405-330-3008
Practice Address - Street 1:3324 OZARK DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-7046
Practice Address - Country:US
Practice Address - Phone:405-816-3539
Practice Address - Fax:405-330-3008
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker