Healthcare Provider Details

I. General information

NPI: 1669465415
Provider Name (Legal Business Name): DANIEL ADAM SHOEMAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SOUTH TWINING ST., BLDG 760 PEDIATRIC CLINIC
MAXWELL AFB AL
36112-6219
US

IV. Provider business mailing address

2130 BRIARWOOD ST
PRATTVILLE AL
36066-7543
US

V. Phone/Fax

Practice location:
  • Phone: 334-953-3113
  • Fax: 334-953-5287
Mailing address:
  • Phone: 334-358-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD417570
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: