Provider Demographics
NPI:1922103522
Name:SHAPIRO, MARK JOHNATHAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JOHNATHAN
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:MARK
Other - Middle Name:JOHNATHAN
Other - Last Name:SHAPIRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:12850 HUNTING BEAR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4351
Mailing Address - Country:US
Mailing Address - Phone:210-691-0412
Mailing Address - Fax:
Practice Address - Street 1:AUDIE MURPHY VA HOSPITAL 7400 MERTON MINTER BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-699-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant