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NPI Code Detail

MEDICARE: MATTHEW W SHOOK M.D.

MEDICARE: MATTHEW W 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
1207Q00000XFamily Medicine PhysicianMD60001658WA
2207Q00000XFamily Medicine PhysicianMD27968OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841487311
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW W SHOOK M.D.
Provider Business Mailing Address
First Line : 8935 SE POWELL BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97266-1938
Country : US
Telephone Number : 503-772-4335
Fax Number : 503-772-4337
Provider Business Practice Location Address
First Line : 8935 SE POWELL BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97266-1938
Country : US
Telephone Number : 503-772-4335
Fax Number : 503-772-4337
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2007
Last Update Date : 02/05/2013

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Directions to “ MATTHEW W SHOOK M.D.” Practice Location

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