Individual
MARK CHARLES SHOPTAUGH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5131 ODONOVAN DR, SUITE 300, BATON ROUGE, LA 70808-4782
(225) 374-0400
(225) 374-0430
Mailing address
5131 ODONOVAN DR, SUITE 300, BATON ROUGE, LA 70808-4782
(225) 374-0400
(225) 374-0430
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
205916
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2107615
—
LA
Enumeration date
04/05/2010
Last updated
06/30/2014
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