Provider Demographics
NPI:1871802033
Name:ALAN F. SHADER, D.P.M
Entity type:Organization
Organization Name:ALAN F. SHADER, D.P.M
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHADER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-681-2600
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:755 E 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1907
Practice Address - Country:US
Practice Address - Phone:305-681-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALAN F. SHADER, D.P.M
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-05
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site