MR. JOHN DAVID SHULL JR. (NPI# 1114325677) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114325677 |
| Entity Type | Individual |
| Full Name | MR. JOHN DAVID SHULL JR. |
| Credential | PA |
| Practice Address |
1520 S Dobson Rd Ste 305 Mesa AZ 85202 |
| Mailing Address |
2222 E Highland Ave Phoenix AZ 85016-4872 |
| Practice Telephone | 4805394000 |
| Practice Fax Number | 4808333040 |
| Mailing Telephone | 6022644834 |
| Mailing Fax Number | 6022545178 |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2019-12-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
5989 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCCPA | 1119977 | 01 | |
| AZ | STATE LICENSE | 5898 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 641 W Warner Rd, Gilbert, AZ 852337266 | 4807229828 | 4807229831 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942212691 | John Albert Shull | Obstetrics & Gynecology | 929 Spring Creek Rd, Suite 203, Chattanooga, TN 37412-3964 | 2006-08-12 |
| Street Address |
1520 S DOBSON RD STE 305 |
| City | MESA |
| State | AZ |
| Zip Code | 85202 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275173536 | Samuel A Wolde | Counselor | Clear View Counseling, 2651 W Guadalupe Rd, Mesa, AZ 85202 | 2020-01-14 |
| 1912549171 | Lauren Barbara Loges | Occupational Therapist | 2225 E. Southern Avenue, Mesa, AZ 85202 | 2019-10-09 |
| 1245724822 | Medsource Orthotics & Prosthetics, Inc | Prosthetic/Orthotic Supplier | 1450 S Dobson Rd Ste B326, Mesa, AZ 85202 | 2018-06-18 |
| 1457843310 | Jay Douglas Baumgardner | Physical Therapist | 1941 W. Guadalupe Rd. Suite 109, Mesa, AZ 85202 | 2018-06-05 |
| 1144746215 | Alyson Fix | Physician Assistant | 1432 S Dobson Rd Ste 304, Mesa, AZ 85202 | 2017-08-20 |
| 1194108852 | Robert Dale Labrum | Counselor | 1255 W Baseline Rd Ste B-258, Mesa, AZ 85202 | 2015-06-30 |
| 1316356207 | Embry Womens Health LLC | Nurse Practitioner | 2204 S Dobson Road, Suite 203, Mesa, AZ 85202 | 2014-08-05 |
| 1619312899 | Fiza Naueed Khan | Internal Medicine | 1400 South Dobson Road, Attn: Bmg Hospitalists Team/amanda Gump, Mesa, AZ 85202 | 2013-05-01 |
| 1487903373 | Jodi Lynn Mealer | Pharmacist | 1951 W. Baseline Rd., Mesa, AZ 85202 | 2012-09-06 |
| 1710240270 | Chad Allen Bowman | Student in an Organized Health Care Education/Training Program | 235 S El Dorado Circle, Mesa, AZ 85202 | 2012-06-20 |
| Find all providers in zip 85202 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790347292 | James M Goldhardt | Physician Assistant | 1400 S Dobson Rd Ste A200, Mesa, AZ 85202-4707 | 2019-07-03 |
| 1801305073 | Panduga Surgical Care, Pllc | Physician Assistant | 4904 S Power Rd Ste 103, Pmb 450, Mesa, AZ 85212-3610 | 2017-09-20 |
| 1679826051 | Az Richardson Surgical Services, LLC | Physician Assistant | 6417 E Star Valley St, Mesa, AZ 85215-0891 | 2012-10-22 |
| 1508173014 | Karli Elizabeth Vierra | Physician Assistant | 1450 S Dobson Rd Ste 320b, Mesa, AZ 85202-4765 | 2010-09-03 |
| 1023335627 | Shawn Christopher Smith | Physician Assistant | 1432 S. Dobson Road, Suite 501, Mesa, AZ 85202 | 2010-04-23 |
| 1144460221 | April M Cadreau | Physician Assistant | 5235 E Southern Ave Ste D106-159, Mesa, AZ 85206 | 2009-03-02 |
| 1598987505 | Patricia Kim Brown | Physician Assistant | 1002 E. Sorenson St., Mesa, AZ 85203 | 2007-05-02 |
| 1275632788 | Justina D Alphin | Physician Assistant | 7525 E Broadway Rd Ste 3, Mesa, AZ 85208-1156 | 2006-09-21 |
| 1750390803 | Daniel Stephen Blake | Physician Assistant | 1839 E Enrose St, Mesa, AZ 85203-5822 | 2006-08-07 |
| 1003820010 | Janie Park | Physician Assistant | 604 W Medina Ave, Mesa, AZ 85210-6848 | 2006-07-27 |
| Find all providers in MESA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.