Healthcare Provider Details

I. General information

NPI: 1477543569
Provider Name (Legal Business Name): JEFFREY M SHAPIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE SUITE 615
ORANGE CA
92868-4223
US

IV. Provider business mailing address

1140 W LA VETA AVE SUITE 615
ORANGE CA
92868-4223
US

V. Phone/Fax

Practice location:
  • Phone: 714-543-8555
  • Fax: 714-543-6555
Mailing address:
  • Phone: 714-543-8555
  • Fax: 714-543-6555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG36478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: