MEDICARE: JACK B SHUMATE M D P A

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	261QM2500X	Medical Specialty Clinic/Center	ME21390	FL

General Provider Information

NPI Number	:	1790847077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACK B SHUMATE M D P A

Provider Business Mailing Address
First Line	:	100 DOCTORS DR
Second Line	:	STE. B
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-7608
Country	:	US
Telephone Number	:	850-872-1300
Fax Number	:	850-872-9420

Provider Business Practice Location Address
First Line	:	100 DOCTORS DR
Second Line	:	STE. B
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-7608
Country	:	US
Telephone Number	:	850-872-1300
Fax Number	:	850-872-9420

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JACK B SHUMATE
Credential	:
Telephone Number	:	850-872-1300

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	08/22/2020

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