Individual
MARK S SHOCKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1220 E 3900 S STE 2C, SALT LAKE CITY, UT 84124-1319
(801) 263-2482
(801) 263-2424
Mailing address
1220 E 3900 S STE 2C, SALT LAKE CITY, UT 84124-1319
(801) 263-2482
(801) 263-2424
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
163879-1205
UT
207RP1001X
Pulmonary Disease Physician
Primary
163879-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107004966101
SELECT CARE
—
01
—
1408
UNIV OF UTAH
—
01
—
36670
DMBA
—
01
—
68893
PEHP
—
01
—
870450466SH1
EMIA
—
01
—
PR07070
MOLINA
—
01
—
QM0000018088
ALTIUS
—
Enumeration date
07/08/2006
Last updated
10/17/2007
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