Individual
DR. MARK S. SHOCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2710 SAINT FRANCIS DR, SUITE 410, WATERLOO, IA 50702-5619
(319) 272-5000
(319) 272-5264
Mailing address
2101 KIMBALL AVE, LL14, WATERLOO, IA 50702-5063
(319) 272-1590
(319) 272-1535
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
34175
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0249706
—
IA
Enumeration date
05/31/2006
Last updated
07/17/2007
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