MEDICARE: DR. DAVID RICHARD SHOOK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0207X	Pediatric Hematology & Oncology Physician	ME122639	FL
2	2080P0207X	Pediatric Hematology & Oncology Physician	42894	TN
3	2080P0207X	Pediatric Hematology & Oncology Physician	170671	CA

General Provider Information

NPI Number	:	1518010164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID RICHARD SHOOK M.D.

Provider Business Mailing Address
First Line	:	1219 DE SOLO DR
Second Line	:
City	:	PACIFICA
State	:	CA
Zip	:	94044-4038
Country	:	US
Telephone Number	:	407-607-6113
Fax Number	:

Provider Business Practice Location Address
First Line	:	1975 4TH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2351
Country	:	US
Telephone Number	:	415-476-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/09/2022

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Directions to “ DR. DAVID RICHARD SHOOK M.D.” Practice Location

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