MEDICARE: ROBERT MELVIN SHULL MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1639486814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT MELVIN SHULL MD PC

Provider Business Mailing Address
First Line	:	8422 E SHEA BLVD
Second Line	:	STE. 103
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-6661
Country	:	US
Telephone Number	:	480-478-6620
Fax Number	:	480-478-6628

Provider Business Practice Location Address
First Line	:	5315 E HIGH ST
Second Line	:	UNIT 410
City	:	PHOENIX
State	:	AZ
Zip	:	85054-5438
Country	:	US
Telephone Number	:	480-478-6620
Fax Number	:	480-478-6628

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT MELVIN SHULL
Credential	:	MD
Telephone Number	:	480-478-6620

Provider Enumeration Date	:	09/09/2010
Last Update Date	:	09/09/2010

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