Individual
BRIAN SHUPLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.T. (R)
Contact information
Practice address
167 NORTH MAIN STREET, TUBA CITY, AZ 86045
(928) 283-2702
Mailing address
167 NORTH MAIN STREET, TUBA CITY, AZ 86045
(928) 283-2702
Taxonomy
Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
Primary
CRT - 11531
AZ
Other
Enumeration date
05/11/2007
Last updated
07/08/2007
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