Provider Demographics
NPI:1891868352
Name:SHOEMAKER, WILLIAM R (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2345 E. PRATER WAY, SUITE 207
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434
Mailing Address - Country:US
Mailing Address - Phone:775-356-9393
Mailing Address - Fax:775-356-5590
Practice Address - Street 1:1389 GALLERIA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6685
Practice Address - Country:US
Practice Address - Phone:725-333-8400
Practice Address - Fax:725-333-8401
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2020-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV5896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVE47377Medicare UPIN
NVV109120Medicare PIN
NVE47377Medicare UPIN
NVNV1274OtherBCROSS-BSHIELD PROV#