Provider Demographics
NPI:1538111901
Name:SHOEMAKER, STEPHEN R (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 MILLIS AVE
Mailing Address - Street 2:SUITE 201 B
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-2242
Mailing Address - Country:US
Mailing Address - Phone:812-897-7381
Mailing Address - Fax:812-897-7331
Practice Address - Street 1:1116 MILLIS AVE
Practice Address - Street 2:SUITE 201 B
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-2242
Practice Address - Country:US
Practice Address - Phone:812-897-7381
Practice Address - Fax:812-897-7331
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND46947Medicare UPIN
IN203590Medicare ID - Type Unspecified