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Organization
LODI PODIATRY GROUP
Active
Organization
LODI PODIATRY GROUP
Active
Other names
SHOCK THOMAS GEN PTR
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KERRY LYN MYERS (OFFICE MANAGER)
(209) 334-0429
Entity
Organization
Contact information
Practice address
1300 W LODI AVE, STE W, LODI, CA 95242-3038
(209) 334-6664
(209) 334-2379
Mailing address
1300 W LODI AVE, STE W, LODI, CA 95242-3038
(209) 334-6664
(209) 334-2379
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
E3241
CA
213E00000X
Podiatrist
Primary
E3467
CA
213ER0200X
Radiology Podiatrist
E3241
CA
213ER0200X
Radiology Podiatrist
E3467
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
E3241
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
E3467
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E32410
—
CA
05
—
000E34670
—
CA
Enumeration date
01/10/2006
Last updated
11/12/2015
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