Organization
MARK SHOPTAUGH JR. MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK CHARLES SHOPTAUGH JR. MD (OWNER)
(225) 603-5935
Entity
Organization
Contact information
Practice address
4363 CONVENTION ST, BATON ROUGE, LA 70806-3906
(225) 522-4076
Mailing address
3133 GRAND WAY AVE, BATON ROUGE, LA 70810-0422
(225) 603-5935
(225) 928-2498
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2107615
—
LA
Enumeration date
10/19/2018
Last updated
10/19/2018
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