MEDICARE: EVAN R SHAPIRO MD

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	:	1528230653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN R SHAPIRO MD

Provider Business Mailing Address
First Line	:	11020 RCA CENTER DR
Second Line	:	SUITE 2014
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4277
Country	:	US
Telephone Number	:	561-625-0700
Fax Number	:	561-691-6025

Provider Business Practice Location Address
First Line	:	11020 RCA CENTER DR
Second Line	:	SUITE 2014
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4277
Country	:	US
Telephone Number	:	561-625-0700
Fax Number	:	561-691-6025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	07/29/2009

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