Individual
MARK EDWARD SHOCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3700 WASHINGTON AVE, EVANSVILLE, IN 47714-0541
(812) 473-0181
(812) 473-5822
Mailing address
PO BOX 3276, EVANSVILLE, IN 47731-3276
(812) 473-0181
(812) 473-5822
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01047527A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000184048
BC
IN
01
—
000000193493
BCBS - DEACONESS MARY ST
IN
01
—
000000501013
BCBS - DEACONESS GATEWAY
IN
05
—
200155630
—
IN
05
—
64297914
—
KY
Enumeration date
10/31/2005
Last updated
05/26/2011
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