Provider Demographics
NPI:1174527089
Name:SHAKESPEARE, HAROLD EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:EUGENE
Last Name:SHAKESPEARE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:777 FLOWER ST
Mailing Address - Street 2:STE A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3000
Mailing Address - Country:US
Mailing Address - Phone:818-637-2000
Mailing Address - Fax:818-242-8761
Practice Address - Street 1:14901 RINALDI ST
Practice Address - Street 2:STE 200
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1204
Practice Address - Country:US
Practice Address - Phone:818-365-8553
Practice Address - Fax:818-365-4524
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2011-04-14
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Provider Licenses
StateLicense IDTaxonomies
CAA19702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A197020Medicaid
CAWA19702DMedicare PIN
CAA82101Medicare UPIN
CAWA19702CMedicare PIN