Basic Information
| Provider Information | |||||||||
| NPI: | 1003800921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAPIRO | ||||||||
| FirstName: | GILBERT | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHAPIRO | ||||||||
| OtherFirstName: | GILBERT | ||||||||
| OtherMiddleName: | D | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DPM, PC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1888 N COUNTRY CLUB RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857163115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203276367 | ||||||||
| FaxNumber: | 5203184492 | ||||||||
| Practice Location | |||||||||
| Address1: | 1888 N COUNTRY CLUB RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857163115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203276367 | ||||||||
| FaxNumber: | 5203184492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 03/11/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | 0173 | AZ | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1003800921 | 01 | AZ | NPI | OTHER | 1033469028 | 01 | AZ | NPI | OTHER | 701111 | 05 | AZ | MEDICAID |