Provider Demographics
NPI:1124044326
Name:MARSHALL D SHOEMAKER MD PC
Entity Type:Organization
Organization Name:MARSHALL D SHOEMAKER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-990-1950
Mailing Address - Street 1:188 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532
Mailing Address - Country:US
Mailing Address - Phone:251-990-1950
Mailing Address - Fax:251-990-1951
Practice Address - Street 1:188 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 304
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-990-1950
Practice Address - Fax:251-990-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529802760Medicaid
ALK351Medicare PIN