Provider Demographics
NPI:1851313399
Name:SHOEMAKER, DREW D (MD)
Entity Type:Individual
Prefix:MR
First Name:DREW
Middle Name:D
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 1:800 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-4855
Mailing Address - Country:US
Mailing Address - Phone:417-893-7700
Mailing Address - Fax:660-882-6093
Practice Address - Street 1:800 S PARK AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-4855
Practice Address - Country:US
Practice Address - Phone:417-893-7700
Practice Address - Fax:660-882-6093
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203784202Medicaid
MO105794OtherBCBS OF MO #
MO80130974Medicare ID - Type UnspecifiedRR MEDICARE #
MO203784202Medicaid
MOG43839Medicare UPIN