Provider Demographics
NPI:1700959764
Name:SHAPARD, CHARLES W (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:SHAPARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E 6TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3661
Mailing Address - Country:US
Mailing Address - Phone:850-785-3185
Mailing Address - Fax:850-785-6233
Practice Address - Street 1:801 E 6TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3661
Practice Address - Country:US
Practice Address - Phone:850-785-3185
Practice Address - Fax:850-785-6233
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA54534207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF66674Medicare UPIN
CA00A545340Medicare ID - Type Unspecified
FL23371Medicare PIN