Provider Demographics
NPI:1972530384
Name:SHOOK, JAMES BERNARD (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BERNARD
Last Name:SHOOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 N LAURENT ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-4119
Mailing Address - Country:US
Mailing Address - Phone:361-579-0315
Mailing Address - Fax:361-579-0325
Practice Address - Street 1:605 E SAN ANTONIO ST
Practice Address - Street 2:STE 508 E
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6040
Practice Address - Country:US
Practice Address - Phone:361-576-1281
Practice Address - Fax:361-576-1337
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3336207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099223203Medicaid
TX8A0021OtherBLUE CROSS
TXC21775Medicare UPIN
TX8A0021OtherBLUE CROSS
TX099223203Medicaid