Individual
JENNIFER MARSH SHUPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
910 E HOUSTON ST, STE 330, TYLER, TX 75702-8369
(903) 510-8848
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
2081N0008X
Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
N6024
TX
2084N0400X
Neurology Physician
Primary
N6024
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214783701
—
TX
01
—
752616977095
TRICARE
TX
01
—
8V3858
BCBS
TX
01
—
TIN PLUS 052
TRICARE
TX
Enumeration date
01/04/2007
Last updated
04/01/2016
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