Healthcare Provider Details

I. General information

NPI: 1952332777
Provider Name (Legal Business Name): ROBERT A SHAPIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/17/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5176 HILL RD E
LAKEPORT CA
95453-6300
US

IV. Provider business mailing address

176C AVENIDA MAJORCA UNIT C
LAGUNA WOODS CA
92637-4149
US

V. Phone/Fax

Practice location:
  • Phone: 707-262-5000
  • Fax:
Mailing address:
  • Phone: 562-208-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA22948
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA22948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: