Provider Demographics
NPI:1851379317
Name:SHOOK, JENNIFER E (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:E
Last Name:SHOOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 W ROSE GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2530
Mailing Address - Country:US
Mailing Address - Phone:602-521-6252
Mailing Address - Fax:623-842-5640
Practice Address - Street 1:19020 33RD AVE W
Practice Address - Street 2:STE 210
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4746
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1374
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000361742085R0202X
AZ275182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA201630OtherL&I PROVIDER NUMBER
WA8234718Medicaid
WA194628OtherL&I PROVIDER NUMBER
WAG8903968Medicare PIN
WAG8856378Medicare PIN
WAG8852367Medicare PIN
WAG47127Medicare UPIN
WAG8921289Medicare PIN
WAG8877336Medicare PIN
WAP00695712Medicare PIN
WA194628OtherL&I PROVIDER NUMBER
WAP00212935Medicare PIN
WA194628OtherL&I PROVIDER NUMBER