Provider Demographics
NPI:1770567182
Name:SHAPIRO, LAURENCE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10666 N TORREY PINES RD
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1027
Mailing Address - Country:US
Mailing Address - Phone:858-554-8638
Mailing Address - Fax:
Practice Address - Street 1:1373 EAST STATE ROAD #62
Practice Address - Street 2:PHOENIX EMERGENCY SERVICES OF MADISON
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-3300
Practice Address - Country:US
Practice Address - Phone:812-810-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68678207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F04437Medicare UPIN