Provider Demographics
NPI:1588648604
Name:SHOEMAKER, MARK C (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:448 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3321
Mailing Address - Country:US
Mailing Address - Phone:559-784-5013
Mailing Address - Fax:559-784-2210
Practice Address - Street 1:448 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3321
Practice Address - Country:US
Practice Address - Phone:559-784-5013
Practice Address - Fax:559-784-2210
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2798213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6297010001Medicare NSC
CAT11471Medicare UPIN