Provider Demographics
NPI:1205155967
Name:SHOOK, JANICE RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:RENEE
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 1:1649 BENNIGAN DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8160
Mailing Address - Country:US
Mailing Address - Phone:614-949-2911
Mailing Address - Fax:
Practice Address - Street 1:776 PRIOR HALL
Practice Address - Street 2:376 WEST 10TH AVENUE
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-293-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS23303207P00000X
MDD77234207P00000X
OH35.125662207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine