Provider Demographics
NPI:1407171440
Name:SHOEMAKE, BRITTANY DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:DIANE
Last Name:SHOEMAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BRITTANY
Other - Middle Name:DIANE
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 742712
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2712
Mailing Address - Country:US
Mailing Address - Phone:877-866-7123
Mailing Address - Fax:
Practice Address - Street 1:17218 PRESTON RD STE 2000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-4018
Practice Address - Country:US
Practice Address - Phone:877-866-7123
Practice Address - Fax:915-591-4069
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4824207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX323358706Medicaid
TX323358702Medicaid