Provider Demographics
NPI:1346207487
Name:SHOOK, JEFFREY E (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
Last Name:SHOOK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5890
Mailing Address - Fax:740-446-5982
Practice Address - Street 1:20 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3452
Practice Address - Country:US
Practice Address - Phone:304-831-1530
Practice Address - Fax:304-831-1527
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00315213ES0103X
OH36.002904213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00787217OtherRAILROAD MEDICARE
OH0227678Medicaid
OH310917085188OtherOH MEDICAID CARESOURCE
OH0227678OtherOH MEDICAID MOLINA
000000264924OtherOH MEDICAID UNISON
WV6420018000Medicaid
WVU60274Medicare UPIN
WV6420018000Medicaid
OHSH0897487Medicare PIN