MEDICARE: ALBEN B. SHOCKLEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	26126	KY
2	207Q00000X	Family Medicine Physician	01036897A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000049664	OTHER	KY	BCBS PIN #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205816014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBEN B. SHOCKLEY M.D.

Provider Business Mailing Address
First Line	:	2211 MAYFAIR DR
Second Line	:	SUITE 101
City	:	OWENSBORO
State	:	KY
Zip	:	42301-4568
Country	:	US
Telephone Number	:	270-688-1352
Fax Number	:	270-683-4313

Provider Business Practice Location Address
First Line	:	151 N GARDENMILE RD
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-5543
Country	:	US
Telephone Number	:	812-485-6030
Fax Number	:	812-485-6032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	12/10/2025

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Directions to “ ALBEN B. SHOCKLEY M.D.” Practice Location

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