Provider Demographics
NPI:1669465415
Name:SHOEMAKER, DANIEL ADAM (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ADAM
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 1:2130 BRIARWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7543
Mailing Address - Country:US
Mailing Address - Phone:334-358-0999
Mailing Address - Fax:
Practice Address - Street 1:300 SOUTH TWINING ST., BLDG 760
Practice Address - Street 2:PEDIATRIC CLINIC
Practice Address - City:MAXWELL AFB
Practice Address - State:AL
Practice Address - Zip Code:36112-6219
Practice Address - Country:US
Practice Address - Phone:334-953-3113
Practice Address - Fax:334-953-5287
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417570208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics