Provider Demographics
NPI:1659321065
Name:SHOEMAKER, MARSHALL DEAN (MD)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:DEAN
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 HOSPITAL DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532
Mailing Address - Country:US
Mailing Address - Phone:251-990-1950
Mailing Address - Fax:251-990-1951
Practice Address - Street 1:188 HOSPITAL DR
Practice Address - Street 2:SUITE 304
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-990-1950
Practice Address - Fax:251-990-1951
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00021413207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000077681Medicaid
B26418Medicare UPIN
AL000077681Medicare ID - Type Unspecified