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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