Provider Demographics
NPI:1902867849
Name:SHUMAKER, ROBERT E (PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:SHUMAKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-3330
Mailing Address - Fax:208-367-3331
Practice Address - Street 1:1075 N CURTIS ROAD
Practice Address - Street 2:STE 300
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-367-3330
Practice Address - Fax:208-367-3331
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-1361363AM0700X
PAMA052341363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ53314Medicare UPIN
PA094979SAHMedicare ID - Type UnspecifiedMEDICARE NUMBER
PA50052879OtherBLUE CROSS NUMBER