Individual
MARK C SHOPTAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8212 SUMMA AVE, BATON ROUGE, LA 70809-3421
(225) 769-4403
(225) 769-3842
Mailing address
7777 HENNESSY BLVD, STE 301, BATON ROUGE, LA 70808-0319
(225) 769-4403
(225) 769-3842
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
017758
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017758
LA STATE MED LIC
LA
Enumeration date
02/20/2007
Last updated
06/21/2016
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