Individual
DR. JON EVERETT SHOPPACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2710 RIFE MEDICAL LANE, ROGERS, AR 72758-1452
(479) 338-8000
(501) 664-0302
Mailing address
PO BOX 2161, LOWELL, AR 72745-2161
(918) 392-1705
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
E-2528
AR
2085R0202X
Diagnostic Radiology Physician
E2528
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142729001
—
AR
Enumeration date
04/18/2006
Last updated
12/17/2019
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