Provider Demographics
NPI:1295882116
Name:WILLIAM L SHOEMAKER D O A MEDICAL CORPORATION
Entity type:Organization
Organization Name:WILLIAM L SHOEMAKER D O A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:619-284-6377
Mailing Address - Street 1:9040 FRIARS RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5859
Mailing Address - Country:US
Mailing Address - Phone:619-284-6377
Mailing Address - Fax:619-241-7581
Practice Address - Street 1:9040 FRIARS RD
Practice Address - Street 2:SUITE 230
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5859
Practice Address - Country:US
Practice Address - Phone:619-284-6377
Practice Address - Fax:619-241-7581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4926207Q00000X
CA20A5747207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty