Provider Demographics
NPI:1518042480
Name:SHOEMAKER, BRUCE RANDY (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:RANDY
Last Name:SHOEMAKER
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 1:309 HEMLOCK DRIVE
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-1631
Mailing Address - Country:US
Mailing Address - Phone:215-443-5950
Mailing Address - Fax:215-443-5140
Practice Address - Street 1:309 HEMLOCK DR
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-1631
Practice Address - Country:US
Practice Address - Phone:215-443-5950
Practice Address - Fax:215-443-5140
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002654-L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASH082547Medicare ID - Type Unspecified
PAT28295Medicare UPIN