Provider Demographics
NPI:1184698706
Name:SHAPIRO, JAY (MD)
Entity type:Individual
Prefix:
First Name:JAY
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 1:1301 BARBARA JORDAN BLVD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723
Mailing Address - Country:US
Mailing Address - Phone:512-478-8116
Mailing Address - Fax:512-478-9368
Practice Address - Street 1:1301 BARBARA JORDAN BLVD.
Practice Address - Street 2:SUITE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723
Practice Address - Country:US
Practice Address - Phone:512-478-8116
Practice Address - Fax:512-478-9368
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8973207X00000X, 207XP3100X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1262032-09Medicaid
TX1262032-10Medicaid
TX1262032-11OtherMEDICAID CSHCN ROT
TX126203208OtherMEDICAID CSHCN
TX87W191OtherBCBS INDIVIDUAL #
TX1262032-12OtherMEDICAID CSHCN AUSTIN
TX126203208OtherMEDICAID CSHCN
TX1262032-12OtherMEDICAID CSHCN AUSTIN