Healthcare Provider Details

I. General information

NPI: 1750400768
Provider Name (Legal Business Name): JEFFREY E SHOOK DPM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 3RD AVE
HUNTINGTON WV
25702-1401
US

IV. Provider business mailing address

2915 3RD AVE
HUNTINGTON WV
25702-1401
US

V. Phone/Fax

Practice location:
  • Phone: 304-755-8088
  • Fax:
Mailing address:
  • Phone: 304-755-8088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00315
License Number StateWV

VIII. Authorized Official

Name: DR. JEFFREY EDWARD SHOOK
Title or Position: PRACTICE MANAGER
Credential: M.D.
Phone: 304-755-8088