Provider Demographics
NPI:1356732630
Name:MARK SCOFIELD MD
Entity type:Organization
Organization Name:MARK SCOFIELD MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-965-2397
Mailing Address - Street 1:1004 1ST ST N
Mailing Address - Street 2:150
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8766
Mailing Address - Country:US
Mailing Address - Phone:205-621-0122
Mailing Address - Fax:205-683-2468
Practice Address - Street 1:1004 1ST ST N
Practice Address - Street 2:150
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8766
Practice Address - Country:US
Practice Address - Phone:205-621-0122
Practice Address - Fax:205-683-2468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL208600000X
AL12767208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty