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General NPI Number Information
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NPI Number | 1992133466
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Entity Type | Organization
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Legal Business Name | DR SHAPE USA, INC
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Dates
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Enumeration Date | 10/21/2013
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Last Update Date | 10/21/2013
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Provider Practice Location Address
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Address Line | 3113 MURDOCH AVE
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City | PARKERSBURG
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State | WV
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Zip | 26101-1018
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Country | US
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Telephone | 304-422-2940
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Fax |
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Provider Business Mailing Address
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Address Line | 3113 MURDOCH AVE
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City | PARKERSBURG
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State | WV
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Zip | 26101-1018
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Country | US
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Telephone | 304-422-2940
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEXANDRE DESOUZA
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Credential | MD
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Telephone | 304-422-2940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 18860
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 18860
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License Number State | WV
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