Provider Demographics
NPI:1245280205
Name:SHAPNICK, DAVID G (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:SHAPNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:305 ASPEN WAY
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-3992
Mailing Address - Country:US
Mailing Address - Phone:406-782-3808
Mailing Address - Fax:406-782-3802
Practice Address - Street 1:401 S ALABAMA ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2315
Practice Address - Country:US
Practice Address - Phone:406-782-3808
Practice Address - Fax:406-782-3802
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7021207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0065790Medicaid
MT0065790Medicaid
MTD24173Medicare UPIN