Provider Demographics
NPI:1275508228
Name:SHOPTAUGH, MARGERY AMY ANNE (MD)
Entity Type:Individual
Prefix:
First Name:MARGERY
Middle Name:AMY ANNE
Last Name:SHOPTAUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:SHOPTAUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3200 E CAMELBACK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2327
Mailing Address - Country:US
Mailing Address - Phone:602-933-1814
Mailing Address - Fax:480-838-5033
Practice Address - Street 1:205 S DOBSON RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6183
Practice Address - Country:US
Practice Address - Phone:602-933-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23894208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
366494OtherPHOENIX HEALTH PLAN
5926009OtherHEALTH NET PIN # 5204
98783OtherPACIFICARE
366494OtherAHCCCS
366494OtherMERCY CARE PLAN
AX0830310OtherBLUE CROSS OF ARIZONA
AX0830310OtherBLUE CROSS OF ARIZONA
BS5330268OtherDEA NUMBER