Healthcare Provider Details

I. General information

NPI: 1588648604
Provider Name (Legal Business Name): MARK C SHOEMAKER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 W PUTNAM AVE
PORTERVILLE CA
93257-3321
US

IV. Provider business mailing address

448 W PUTNAM AVE
PORTERVILLE CA
93257-3321
US

V. Phone/Fax

Practice location:
  • Phone: 559-784-5013
  • Fax: 559-784-2210
Mailing address:
  • Phone: 559-784-5013
  • Fax: 559-784-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE2798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: