Provider Demographics
NPI:1306831177
Name:SHOPE, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:SHOPE
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 1:90 N 4TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-1648
Mailing Address - Country:US
Mailing Address - Phone:740-633-4303
Mailing Address - Fax:740-633-4774
Practice Address - Street 1:90 N 4TH ST FL 2
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1648
Practice Address - Country:US
Practice Address - Phone:740-633-4303
Practice Address - Fax:740-633-4774
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV194132086S0122X
OH350600192086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0114218000Medicaid
OH0939524Medicaid
OHP00422394OtherRAILROAD MEDICARE
WV0114218000Medicaid
WV240007274Medicare PIN
WA0748226Medicare ID - Type Unspecified
WV0114218000Medicaid