Provider Demographics
NPI:1114325677
Name:SHULL, JOHN DAVID JR (PA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:SHULL
Suffix:JR
Gender:M
Credentials:PA
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Mailing Address - Street 1:4530 E SHEA BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6042
Mailing Address - Country:US
Mailing Address - Phone:602-264-4834
Mailing Address - Fax:602-254-5178
Practice Address - Street 1:1520 S DOBSON RD STE 217
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4754
Practice Address - Country:US
Practice Address - Phone:480-539-4000
Practice Address - Fax:480-833-3040
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2024-04-04
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Provider Licenses
StateLicense IDTaxonomies
AZ5989363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1119977OtherNCCPA
AZ5898OtherSTATE LICENSE