Provider Demographics
NPI:1669497699
Name:SHOEMAKE, JOSHUA K (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:K
Last Name:SHOEMAKE
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:PO BOX 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:704-302-9300
Mailing Address - Fax:704-302-9301
Practice Address - Street 1:4525 CAMERON VALLEY PKWY
Practice Address - Street 2:SUITE 3100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4369
Practice Address - Country:US
Practice Address - Phone:704-302-9300
Practice Address - Fax:704-302-9301
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400164207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00247533OtherMEDICARE RAILROAD
SCN0061BMedicaid
NC140KAOtherBCBS OF NC
NC5902003Medicaid
NC2046330AMedicare PIN
NC2046330BMedicare PIN
NC140KAOtherBCBS OF NC
NC5902003Medicaid