Provider Demographics
NPI:1225124829
Name:LINDSEY, MARK SHOFNER (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SHOFNER
Last Name:LINDSEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 ST. LUKES DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117
Mailing Address - Country:US
Mailing Address - Phone:334-213-3606
Mailing Address - Fax:334-213-3608
Practice Address - Street 1:370 ST. LUKES DRIVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117
Practice Address - Country:US
Practice Address - Phone:334-213-3606
Practice Address - Fax:334-213-3608
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000028802Medicaid
AL28802OtherBLUE CROSS
AL0110087OtherUNITED
AL28802OtherBLUE CROSS
ALE83268Medicare UPIN