Healthcare Provider Details

I. General information

NPI: 1710998331
Provider Name (Legal Business Name): DAVID W. SHOEMAKER, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W POPLAR ST
WALLA WALLA WA
99362-2846
US

IV. Provider business mailing address

1192 LAWSON LN
WALLA WALLA WA
99362-7250
US

V. Phone/Fax

Practice location:
  • Phone: 509-525-3320
  • Fax:
Mailing address:
  • Phone: 509-526-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberMD00029733
License Number StateWA

VIII. Authorized Official

Name: DR. DAVID W. SHOEMAKER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 509-540-9258