MEDICARE: EVAN R. SHAPIRO, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME0063565	FL

General Provider Information

NPI Number	:	1316945470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVAN R. SHAPIRO, M.D., P.A.

Provider Business Mailing Address
First Line	:	600 UNIVERSITY BLVD
Second Line	:	SUITE 200-B
City	:	JUPITER
State	:	FL
Zip	:	33458-2778
Country	:	US
Telephone Number	:	561-625-0700
Fax Number	:	561-691-6025

Provider Business Practice Location Address
First Line	:	600 UNIVERSITY BLVD
Second Line	:	SUITE 200-B
City	:	JUPITER
State	:	FL
Zip	:	33458-2778
Country	:	US
Telephone Number	:	561-625-0700
Fax Number	:	561-691-6025

Authorized Official
Title or Position	:	PHYSICIAN/PRESIDENT OF P.A.
Name	:	DR. EVAN ROBERT SHAPIRO
Credential	:	M.D.
Telephone Number	:	561-625-0700

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	09/21/2007

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