MEDICARE: DOUGLAS SHAPIRO DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS19369	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356964910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS SHAPIRO DO

Provider Business Mailing Address
First Line	:	877 W FARIS RD STE A
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4296
Country	:	US
Telephone Number	:	864-923-2643
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 W KENNEDY BLVD STE 214
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2244
Country	:	US
Telephone Number	:	813-727-3233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2020
Last Update Date	:	06/19/2023

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Directions to “ DOUGLAS SHAPIRO DO” Practice Location

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