Individual
MR. JOHN DAVID SHULL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1520 S DOBSON RD STE 217, MESA, AZ 85202-4754
(480) 539-4000
(480) 833-3040
Mailing address
4530 E SHEA BLVD STE 180, PHOENIX, AZ 85028-6042
(602) 264-4834
(602) 254-5178
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5989
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1119977
NCCPA
—
01
—
5898
STATE LICENSE
AZ
Enumeration date
12/16/2014
Last updated
04/04/2024
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