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General NPI Number Information
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NPI Number | 1336283779
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Entity Type | Individual
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Provider Name | GLEN DAVID SHAPIRO MD
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Gender | Male
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 05/23/2012
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Provider Practice Location Address
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Address Line | 513 N MAIN ST
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City | HAILEY
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State | ID
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Zip | 83333
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Country | US
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Telephone | 877-754-6330
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Fax | 877-993-1515
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Provider Business Mailing Address
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Address Line | 1420 N 2ND AVE
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City | HAILEY
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State | ID
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Zip | 83333
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Country | US
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Telephone | 877-754-6330
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Fax | 877-993-1515
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | M9172
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License Number State | ID
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