Provider Demographics
NPI:1487673471
Name:SHUMATE, GORDON JULIAN JR (DPM)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:JULIAN
Last Name:SHUMATE
Suffix:JR
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 1:405 SOUTH ST STE F
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2101
Mailing Address - Country:US
Mailing Address - Phone:530-246-4800
Mailing Address - Fax:530-246-4802
Practice Address - Street 1:405 SOUTH ST STE F
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2101
Practice Address - Country:US
Practice Address - Phone:530-246-4800
Practice Address - Fax:530-246-4802
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3936213EP1101X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E39360Medicaid
CA000E39360Medicaid
CAU50911Medicare UPIN