1841476397 NPI number — STEVEN K SHOEMAKER DPM

Table of content: STEVEN K SHOEMAKER DPM (NPI 1841476397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841476397 NPI number — STEVEN K SHOEMAKER DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHOEMAKER
Provider First Name:
STEVEN
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841476397
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4120 DOUGLAS BLVD
Provider Second Line Business Mailing Address:
#306 -165
Provider Business Mailing Address City Name:
GRANITE BAY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95746-5936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-781-3223
Provider Business Mailing Address Fax Number:
916-781-3019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1421 SECRET RAVINE PKWY
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-6045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-781-3223
Provider Business Practice Location Address Fax Number:
916-781-3019
Provider Enumeration Date:
01/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  E3540 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00293318 . This is a "RAIL ROAD MEDICARE INDIVIDUAL PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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