DR. MARK MIDDLEBROOKS (NPI# 1992883326) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992883326 |
| Entity Type | Individual |
| Full Name | DR. MARK MIDDLEBROOKS |
| Credential | PHARM.D. |
| Practice Address |
1541 Kings Hwy Shreveport LA 71103-4228 |
| Mailing Address |
5512 Lake Side Dr Bossier City LA 71111-5504 |
| Practice Telephone | 3186755176 |
| Mailing Telephone | 3187474638 |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1835P1200X |
Pharmacist Specialization: Pharmacotherapy |
29787 | TX | Pharmacy Service Providers |
| Y | 1835P1200X |
Pharmacist Specialization: Pharmacotherapy |
11169 | LA | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679692073 | Mark T Middlebrooks | Social Worker | 614 W Main St, #102, League City, TX 77573-3771 | 2007-03-28 |
| Street Address |
1541 KINGS HWY |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71103-4228 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912909912 | Brfhh Shreveport LLC | General Acute Care Hospital | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2005-08-10 |
| 1851991947 | Gina Marie Kristiansen | Nurse Practitioner | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-10-28 |
| 1376142893 | Candice Crow | Internal Medicine | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-10-26 |
| 1518574441 | Jadebrey Vyshette Kennon | Nurse Practitioner | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-09-24 |
| 1629683230 | Amanda Renae Simmons | Physician Assistant | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-09-10 |
| 1255945382 | Frank James List | Pharmacy Technician | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-09-05 |
| 1700496312 | Caroline Leigh Harris | Physician Assistant | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-08-07 |
| 1740899400 | Brittany Allyson Bozzell | Physician Assistant | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-07-29 |
| 1386253169 | Kristyn Turner | Pharmacist | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-07-28 |
| 1508481722 | Alexandra Blair Lemaire | Physician Assistant | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-06-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083124887 | Elizabeth Ponder | Case Manager/Care Coordinator | 404 Hearne Avenue, Shreveport, LA 71103 | 2017-10-05 |
| 1245648393 | Madiha Tariq | General Acute Care Hospital | Rheumatology Clinic, 1501 Kings Hwy, Sheveport, LA 71103 | 2014-07-31 |
| 1659782688 | Jennifer G Smith | Pharmacist | 1725 Claiborne Ave, Shreveport, LA 71103 | 2014-05-13 |
| 1336568823 | Taylor Jieun Jung | Student in an Organized Health Care Education/Training Program | Lsu Health Sciences Center 1501 Kings Highway, Department of Oral & Maxillofacial Surgery Room 530, Shreveport, LA 71103 | 2014-04-10 |
| 1578984746 | Jamie Terrell | Pharmacist | 1625 Claiborne Ave, Shreveport, LA 71103 | 2013-12-13 |
| 1346675188 | Srijan Tandukar | Internal Medicine | 2751 Albert L Bicknell Dr Ste 2b, Shreveport, LA 71103 | 2013-09-12 |
| 1699017681 | Deanna Elise Mossallati | Internal Medicine | 8551 Greenwood Rd, Suite 410, Shreveport, LA 71103 | 2013-03-18 |
| 1346527330 | Tim M Smith | Clinical Exercise Physiologist | 3200 Greenwood Rd., Shreveport, LA 71103 | 2011-11-04 |
| 1144451683 | Second Chance Recovery | Durable Medical Equipment & Medical Supplies | 3816 Linwood, Shreveport, LA 71103 | 2009-07-31 |
| 1093919920 | Neeraj Singh | Internal Medicine | 2751 Albert L Bicknell Dr Fl 4, Shreveport, LA 71103 | 2007-06-13 |
| Find all providers in zip 71103 | ||||
| Taxonomy Code | 1835P1200X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacotherapy |
| A licensed pharmacist who has demonstrated specialized knowledge and skill in optimizing pharmacotherapeutic care of patients, by developing, implementing, monitoring, and modifying complex treatment plans, providing advanced level education and consultation, and collaborating with other health professionals in the management of therapy. |
| Notes: Source: Specialty certification and recertification program administered by Board of Pharmaceutical Specialties, www.bpsweb.org [7/1/2006: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659782688 | Jennifer G Smith | Pharmacist | 1725 Claiborne Ave, Shreveport, LA 71103 | 2014-05-13 |
| 1235184425 | Tibb Marie Jacobs | Pharmacist | Lsu Health Sciences Center, 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2006-05-24 |
| 1376174797 | Jaime Hulsey | Pharmacist | 8001 Youree Dr, Shreveport, LA 71115-2302 | 2020-02-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487076956 | Angela Daigle | Pharmacist | 335 High View Park Ln, Arnaudville, LA 70512-6447 | 2014-01-17 |
| 1366781247 | Jessica Helmer Brady | Pharmacist | 1800 Bienville Dr, Monroe, LA 71201-3765 | 2013-02-12 |
| 1982967790 | Kerry Fine | Pharmacist | 1512 Jefferson Hwy, Jefferson, LA 70121-2429 | 2012-06-18 |
| 1841573599 | Linda Keys | Pharmacist | 1107 Veterans Blvd, Metairie, LA 70005 | 2011-09-20 |
| 1114176930 | Nicole Theresa Fabre-lacoste | Pharmacist | 977 N Carrollton Ave, New Orleans, LA 70119-3741 | 2008-09-17 |
| 1427207661 | Clyde Norris Dearman | Pharmacist | 130 Desiard St Ste 300, Monroe, LA 71201-7363 | 2008-09-11 |
| 1992990287 | Shannon Denise Bagnet-finley | Pharmacist | 19100 Dr John Lambert Dr, Hammond, LA 70403-0922 | 2007-09-10 |
| 1780891812 | Thrifty Way | Pharmacist | 1019 W Fertitta Blvd, Leesville, LA 71446-4646 | 2007-05-17 |
| 1821203837 | Leopold Goudchaux | Pharmacist | 5504 Navaho Trl, Alexandria, LA 71301-2830 | 2007-05-12 |
| 1134332968 | Johnson Sullivan Fairbanks | Pharmacist | 1527 Mohon St, Alexandria, LA 71301-3431 | 2007-05-08 |
| Find all providers with the same taxonomy | ||||
| City | SHREVEPORT |
| Zip Code | 71103 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.