Healthcare Provider Details

I. General information

NPI: 1164405270
Provider Name (Legal Business Name): MARK L SHAPIRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E BROAD ST STE 421
MANSFIELD TX
76063-6415
US

IV. Provider business mailing address

2800 E BROAD ST STE 421
MANSFIELD TX
76063-6415
US

V. Phone/Fax

Practice location:
  • Phone: 469-695-2028
  • Fax: 469-695-2029
Mailing address:
  • Phone: 469-695-2028
  • Fax: 469-695-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMC-0787
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number219511
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD23567
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2006-01252
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD61612669
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberV4068
License Number StateTX
# 7
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberEMC0000656
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: