Healthcare Provider Details

I. General information

NPI: 1174123608
Provider Name (Legal Business Name): RALPH LANDON SHOEMAKER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 N 11TH ST
RICHMOND VA
23298-5024
US

IV. Provider business mailing address

2307 KROSSRIDGE CT
NORTH CHESTERFIELD VA
23236-5215
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-8786
  • Fax:
Mailing address:
  • Phone: 256-343-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0116042569
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: