MEDICARE: JAMES EDWARD SHOEMAKER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY6776	CA

General Provider Information

NPI Number	:	1750318507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES EDWARD SHOEMAKER PH.D.

Provider Business Mailing Address
First Line	:	2650 KADEMA DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95864-6914
Country	:	US
Telephone Number	:	916-443-0974
Fax Number	:	916-254-0112

Provider Business Practice Location Address
First Line	:	5411 MADISON AVE
Second Line	:	STE # 1
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-3151
Country	:	US
Telephone Number	:	916-332-6051
Fax Number	:	916-332-6053

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	05/26/2010

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