Provider Demographics
NPI:1750400768
Name:JEFFREY E SHOOK DPM PLLC
Entity type:Organization
Organization Name:JEFFREY E SHOOK DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SHOOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-755-8088
Mailing Address - Street 1:2915 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1401
Mailing Address - Country:US
Mailing Address - Phone:304-755-8088
Mailing Address - Fax:
Practice Address - Street 1:2915 3RD AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1401
Practice Address - Country:US
Practice Address - Phone:304-755-8088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00315213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0227678Medicaid
DF7723OtherRAILROAD
WV6420018000Medicaid
WV9368591Medicare PIN