Provider Demographics
NPI:1700815537
Name:IRA SHAFRAN, MD, PA
Entity Type:Organization
Organization Name:IRA SHAFRAN, MD, PA
Other - Org Name:SHAFRAN GASTROENTEROLOGY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-629-8121
Mailing Address - Street 1:701 W MORSE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3731
Mailing Address - Country:US
Mailing Address - Phone:407-629-8121
Mailing Address - Fax:407-629-7250
Practice Address - Street 1:701 W MORSE BLVD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3731
Practice Address - Country:US
Practice Address - Phone:407-629-8121
Practice Address - Fax:407-629-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0033950207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0797Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER