Provider Demographics
NPI:1588745483
Name:ROOF, SHAUN R (DO)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:R
Last Name:ROOF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:88 MCMILLEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055
Mailing Address - Country:US
Mailing Address - Phone:740-348-4270
Mailing Address - Fax:740-348-4272
Practice Address - Street 1:88 MCMILLEN DRIVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055
Practice Address - Country:US
Practice Address - Phone:740-348-4270
Practice Address - Fax:740-348-4272
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39474207Y00000X
OH34.006678207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology