Provider Demographics
NPI:1861533259
Name:SHAPIRO, RONALD BRUCE (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:BRUCE
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 1:1110 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722-2211
Mailing Address - Country:US
Mailing Address - Phone:512-320-8388
Mailing Address - Fax:512-320-8398
Practice Address - Street 1:1110 E 32ND ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722-2211
Practice Address - Country:US
Practice Address - Phone:512-320-8388
Practice Address - Fax:512-320-8398
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK70992080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132142407Medicaid
TX132142407Medicaid