Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | E2798 | CA |
NPI | 1588648604 |
---|---|
Provider Name | Dr. Mark C Shoemaker |
First Address | Porterville, CA 93257-3321 |
Second Address | Porterville, CA 93257-3321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 14/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T11471 | (02) | CA |