Provider Demographics
NPI:1811077712
Name:SHOEMAKER, BENJAMIN EDGAR (MD)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:EDGAR
Last Name:SHOEMAKER
Suffix:
Gender:M
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:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015
Mailing Address - Country:US
Mailing Address - Phone:615-792-2280
Mailing Address - Fax:615-792-1261
Practice Address - Street 1:302 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-1306
Practice Address - Country:US
Practice Address - Phone:615-792-2280
Practice Address - Fax:615-792-1261
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD18084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44DO986946OtherCLIA MEDICARE
TN3852908Medicaid
TN3163048OtherBCBS
TN3852908Medicare ID - Type Unspecified
TN44DO986946OtherCLIA MEDICARE