Individual
IAN THOMAS SHUPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPAS, PA-C, RT(R)
Contact information
Practice address
842 E MAIN ST, MEDFORD, OR 97504-7155
(541) 618-5800
(541) 779-3027
Mailing address
17607 SW FALLING LEAF CT, BEAVERTON, OR 97003-7558
(360) 991-2491
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA.PA.61159625
WA
363A00000X
Physician Assistant
Primary
PA204375
OR
Other
Enumeration date
05/19/2021
Last updated
05/19/2021
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