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General NPI Number Information
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NPI Number | 1346207487
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Entity Type | Individual
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Provider Name | JEFFREY E SHOOK DPM
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Gender | Male
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 20 HOSPITAL DR
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City | LOGAN
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State | WV
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Zip | 25601-3452
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Country | US
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Telephone | 304-831-1530
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Fax | 304-831-1527
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Provider Business Mailing Address
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Address Line | 90 JACKSON PIKE
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City | GALLIPOLIS
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State | OH
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Zip | 45631-1560
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Country | US
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Telephone | 740-446-5890
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Fax | 740-446-5982
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 00315
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 36.002904
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License Number State | OH
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