Healthcare Provider Details

I. General information

NPI: 1659321065
Provider Name (Legal Business Name): MARSHALL DEAN SHOEMAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 HOSPITAL DR SUITE 304
FAIRHOPE AL
36532
US

IV. Provider business mailing address

188 HOSPITAL DR SUITE 304
FAIRHOPE AL
36532
US

V. Phone/Fax

Practice location:
  • Phone: 251-990-1950
  • Fax: 251-990-1951
Mailing address:
  • Phone: 251-990-1950
  • Fax: 251-990-1951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number00021413
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: