Provider Demographics
NPI:1740803626
Name:SHOEMAKER, JASON DON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DON
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 PHEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2443
Mailing Address - Country:US
Mailing Address - Phone:580-380-7537
Mailing Address - Fax:
Practice Address - Street 1:5202 PHEASANT RUN
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2443
Practice Address - Country:US
Practice Address - Phone:580-380-7537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator