Individual
MARK EDWARD SHOCKLEY
Active
Individual
MARK EDWARD SHOCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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