Provider Demographics
NPI:1245598143
Name:SHAMP, JOSEPH EDWARD (BE BOCO, LPOA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:SHAMP
Suffix:
Gender:M
Credentials:BE BOCO, LPOA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 S 79TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-6250
Mailing Address - Country:US
Mailing Address - Phone:479-484-1620
Mailing Address - Fax:479-484-1619
Practice Address - Street 1:3500 S 79TH ST STE A
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6250
Practice Address - Country:US
Practice Address - Phone:479-484-1620
Practice Address - Fax:479-484-1619
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROPPA0006222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AROPPA0006OtherARKANSAS BOARD OF MEDICAL LICENSING FOR O&P