Provider Demographics
NPI:1386679215
Name:SCOFIELD, WILLIAM MARK (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARK
Last Name:SCOFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8817
Mailing Address - Country:US
Mailing Address - Phone:205-621-0145
Mailing Address - Fax:205-664-2420
Practice Address - Street 1:632 2ND ST NE
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8817
Practice Address - Country:US
Practice Address - Phone:205-621-0145
Practice Address - Fax:205-664-2420
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12767208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL103I024232OtherMEDICARE PTAN
1710202OtherUNITED HEALTHCARE
AL05108325SCOOtherBLUE CROSS
AL176555Medicaid
AL176555Medicaid