Provider Demographics
NPI:1356964910
Name:SHAPIRO, DOUGLAS (DO)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 W FARIS RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4296
Mailing Address - Country:US
Mailing Address - Phone:864-923-2643
Mailing Address - Fax:
Practice Address - Street 1:4100 W KENNEDY BLVD STE 214
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2244
Practice Address - Country:US
Practice Address - Phone:813-727-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS19369207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine