Provider Demographics
NPI:1881632784
Name:SHOEMAKER, SCOTT L (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
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 1:17150 EUCLID ST
Mailing Address - Street 2:STE 320
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-432-1321
Mailing Address - Fax:714-434-1890
Practice Address - Street 1:17150 EUCLID ST
Practice Address - Street 2:STE 320
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-432-1321
Practice Address - Fax:714-434-1890
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG719642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G719640OtherBLUE SHIELD
CAW13062Medicare ID - Type Unspecified
E98411Medicare UPIN