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General NPI Number Information
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NPI Number | 1659481620
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Entity Type | Individual
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Provider Name | ALAN FRED SHADER DPM
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 3800 WEST 12TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012
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Country | US
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Telephone | 305-681-2600
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Fax | 305-685-5098
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Provider Business Mailing Address
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Address Line | 3800 W 12TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-7793
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Country | US
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Telephone | 305-681-2600
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Fax | 305-685-0906
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO001468
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License Number State | FL
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