Provider Demographics
NPI:1497053540
Name:SHOEMAKER, JASON DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:DANIEL
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-0536
Mailing Address - Country:US
Mailing Address - Phone:740-587-1361
Mailing Address - Fax:740-587-1362
Practice Address - Street 1:7450 HOSPITAL DR STE 150
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9641
Practice Address - Country:US
Practice Address - Phone:614-766-5050
Practice Address - Fax:740-766-8080
Is Sole Proprietor?:No
Enumeration Date:2011-03-13
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011844208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0126647Medicaid