Individual
JEFFREY E SHOOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
20 HOSPITAL DR, LOGAN, WV 25601-3452
(304) 831-1530
(304) 831-1527
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5890
(740) 446-5982
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
00315
WV
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
36.002904
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000264924
OH MEDICAID UNISON
—
01
—
0227678
OH MEDICAID MOLINA
OH
05
—
0227678
—
OH
01
—
310917085188
OH MEDICAID CARESOURCE
OH
05
—
6420018000
—
WV
01
—
P00787217
RAILROAD MEDICARE
OH
Enumeration date
05/01/2006
Last updated
06/29/2010
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