Provider Demographics
NPI:1790896421
Name:SHAPIRO, PAUL (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3330 N 2ND ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2368
Mailing Address - Country:US
Mailing Address - Phone:602-264-1031
Mailing Address - Fax:602-264-3864
Practice Address - Street 1:3330 N 2ND ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2368
Practice Address - Country:US
Practice Address - Phone:602-264-1031
Practice Address - Fax:602-264-3864
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ0219213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0737160001OtherNORIDIAN DME
AZ480003915OtherRAILROAD MEDICARE
AZ700410Medicaid
AZAZ0068860OtherBCBS OF ARIZONA
AZ480003915OtherRAILROAD MEDICARE
AZ700410Medicaid