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General NPI Number Information
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NPI Number | 1568420404
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Entity Type | Individual
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Provider Name | THOMAS W SHOOKMAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 1700 TUTTLE ST
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City | BARABOO
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State | WI
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Zip | 53913-3319
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Country | US
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Telephone | 608-355-3800
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Fax | 608-355-7001
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Provider Business Mailing Address
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Address Line | 1700 TUTTLE ST
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City | BARABOO
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State | WI
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Zip | 53913-3319
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Country | US
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Telephone | 608-355-3800
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Fax | 608-355-7001
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 62-023
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License Number State | WI
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