Provider Demographics
NPI:1518018530
Name:SHOEMAKER, JAMES RICHARD (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W. GRANADA BLVD.
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:386-677-0453
Mailing Address - Fax:386-677-0463
Practice Address - Street 1:77 W. GRANADA BLVD.
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-677-0453
Practice Address - Fax:386-677-0463
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD77253Medicare UPIN
FL39678Medicare ID - Type UnspecifiedMEDICARE GROUP #
FL81860Medicare ID - Type UnspecifiedPERSONAL MCARE #