Basic Information
| Provider Information | |||||||||
| NPI: | 1437153400 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHOEMAKER | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | STANTON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5920 SARATOGA BLVD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784144105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3619936000 | ||||||||
| FaxNumber: | 3619933676 | ||||||||
| Practice Location | |||||||||
| Address1: | 7121 S SPID DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784124940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3619936000 | ||||||||
| FaxNumber: | 3619933676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2005 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VB0002X | E1133 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Bariatric Medicine | 207V00000X | E1133 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 044729401 | 05 | TX | MEDICAID |