MEDICARE: MARK EDWARD SHOCKLEY MD

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	207L00000X	Anesthesiology Physician	01047527A	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	000000501013	OTHER	IN	BCBS - DEACONESS GATEWAY
3	000000184048	OTHER	IN	BC
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000193493	OTHER	IN	BCBS - DEACONESS MARY ST

General Provider Information

NPI Number	:	1437140365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK EDWARD SHOCKLEY MD

Provider Business Mailing Address
First Line	:	PO BOX 3276
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47731-3276
Country	:	US
Telephone Number	:	812-473-0181
Fax Number	:	812-473-5822

Provider Business Practice Location Address
First Line	:	3700 WASHINGTON AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-0541
Country	:	US
Telephone Number	:	812-473-0181
Fax Number	:	812-473-5822

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	05/26/2011

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Directions to “ MARK EDWARD SHOCKLEY MD” Practice Location

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