Provider Demographics
NPI:1023080405
Name:SHUMWAY, DON A (DPM)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:A
Last Name:SHUMWAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 S MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5582
Mailing Address - Country:US
Mailing Address - Phone:928-536-4253
Mailing Address - Fax:928-536-5942
Practice Address - Street 1:1083 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5582
Practice Address - Country:US
Practice Address - Phone:928-536-4253
Practice Address - Fax:928-536-5942
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ0538213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ589335Medicaid
Z85740Medicare ID - Type Unspecified
U90203Medicare UPIN