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General NPI Number Information
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NPI Number | 1639167687
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Entity Type | Individual
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Provider Name | MICHAEL DAVID SHOEMAKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 1800 COMMUNITY
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City | CLINTON
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State | MO
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Zip | 64735
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Country | US
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Telephone | 844-853-8937
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 COMMUNITY
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City | CLINTON
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State | MO
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Zip | 64735-8804
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Country | US
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Telephone | 660-885-8131
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2002014469
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License Number State | MO
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