Active NPI
Mark E Shertzer, MD
- Anatomic Pathology & Clinical Pathology Physician
- Dothan, AL
National Provider Identifier
1568433985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 00011617
- Practice address
- 1108 Ross Clark Cir
Dothan, AL 36301-3022 - Phone
- (334) 671-1696
- Fax
- (334) 794-0721
- NPI assigned
- Feb 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 00011617 | AL | Primary |
Addresses
Primary practice location
1108 Ross Clark Cir
Dothan, AL 36301-3022
Mailing address
2015 Alexander Dr
Dothan, AL 36301-3003
Phone (334) 671-1696
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000039346 | Medicaid | AL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00011617 | AL | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Houston County Healthcare Authority | Current | Accepting new patients | |
| Medcore Associates, PLLC | Anatomic Pathology & Clinical Pathology | Current | Accepting new patients |
| Houston County Healthcare Authority | Current | Accepting new patients |
Locations
1108 Ross Clark Cir
Dothan, AL 36301
Phone (334) 712-3635
1118 Ross Clark Cir
Ste 500
Dothan, AL 36301
Phone (334) 794-4159
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Dothan, AL
- NPI 1285783134
-
- Internal Medicine Physician
- Dothan, AL
- NPI 1538597349
-
- Anatomic Pathology & Clinical Pathology Physician
- Dothan, AL
- NPI 1992524607
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263427200000",
"number": "1568433985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2015 ALEXANDER DR",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363013003",
"telephone_number": "334-671-1696",
"fax_number": "334-794-0721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1108 ROSS CLARK CIR",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363013022",
"telephone_number": "334-671-1696",
"fax_number": "334-794-0721"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHERTZER",
"first_name": "MARK",
"middle_name": "E",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-01",
"last_updated": "2010-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "AL",
"license": "00011617",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000039346",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Dothan, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.