| Mark Shoptaugh, Jr., M.d., Psychiatry, L.l.c. | |
|
7865 Jefferson Hwy Ste D Baton Rouge LA 70809-1384 | |
| (225) 928-2468 | |
| (225) 928-2498 |
| Full Name | Mark Shoptaugh, Jr., M.d., Psychiatry, L.l.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 7865 Jefferson Hwy Ste D, Baton Rouge, Louisiana |
| Authorized Official Name and Position | Mark Charles Shoptaugh (OWNER) |
| Authorized Official Contact | 2259282468 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Shoptaugh, Jr., M.d., Psychiatry, L.l.c. 7865 Jefferson Hwy Ste D Baton Rouge LA 70809-1384 Ph: (225) 928-2468 | Mark Shoptaugh, Jr., M.d., Psychiatry, L.l.c. 7865 Jefferson Hwy Ste D Baton Rouge LA 70809-1384 Ph: (225) 928-2468 |
| NPI Number | 1588176150 |
|---|---|
| Provider Enumeration Date | 11/03/2017 |
| Last Update Date | 12/06/2017 |
| Medicare PECOS PAC ID | 5597022186 |
|---|---|
| Medicare Enrollment ID | O20171207000689 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588176150 | NPI | - | NPPES |
| 2107615 | Other | LA | MARK SHOPTAUGH JR. MD MEDICAID NUMBER (NOT FOR LLC) |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | MD205916 (Louisiana) | Primary |
| Provider Name | Mark C Shoptaugh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417272253 PECOS PAC ID: 6608093026 Enrollment ID: I20140808000725 |
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