Provider Demographics
NPI:1497333520
Name:SHRUM, AVERY BLAKE (DO)
Entity type:Individual
Prefix:DR
First Name:AVERY
Middle Name:BLAKE
Last Name:SHRUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1988
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-1988
Mailing Address - Country:US
Mailing Address - Phone:606-435-7642
Mailing Address - Fax:606-436-5282
Practice Address - Street 1:425 HINDMAN BYP
Practice Address - Street 2:
Practice Address - City:HINDMAN
Practice Address - State:KY
Practice Address - Zip Code:41822-8666
Practice Address - Country:US
Practice Address - Phone:606-439-1300
Practice Address - Fax:606-439-1400
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY05838207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine