Provider Demographics
NPI:1588176150
Name:MARK SHOPTAUGH, JR., M.D., PSYCHIATRY, L.L.C.
Entity Type:Organization
Organization Name:MARK SHOPTAUGH, JR., M.D., PSYCHIATRY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SHOPTAUGH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:225-928-2468
Mailing Address - Street 1:7865 JEFFERSON HWY STE D
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1384
Mailing Address - Country:US
Mailing Address - Phone:225-928-2468
Mailing Address - Fax:225-928-2498
Practice Address - Street 1:7865 JEFFERSON HWY STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1384
Practice Address - Country:US
Practice Address - Phone:225-928-2468
Practice Address - Fax:225-928-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD2059162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2107615OtherMARK SHOPTAUGH JR. MD MEDICAID NUMBER (NOT FOR LLC)