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NPI Code Detail

MEDICARE: MR. LUCAS SHOEMAKER

MEDICARE:  MR. LUCAS  SHOEMAKER
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1568940815
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LUCAS SHOEMAKER
Provider Business Mailing Address
First Line : 24962 OKAY RD
Second Line :
City : TECUMSEH
State : OK
Zip : 74873-6504
Country : US
Telephone Number : 405-253-2020
Fax Number :
Provider Business Practice Location Address
First Line : 24962 OKAY RD
Second Line :
City : TECUMSEH
State : OK
Zip : 74873-6504
Country : US
Telephone Number : 405-253-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2018
Last Update Date : 07/30/2018

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Directions to “ MR. LUCAS SHOEMAKER ” Practice Location

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