Healthcare Provider Details

I. General information

NPI: 1639486814
Provider Name (Legal Business Name): ROBERT MELVIN SHULL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5315 E HIGH ST UNIT 410
PHOENIX AZ
85054-5438
US

IV. Provider business mailing address

8422 E SHEA BLVD STE. 103
SCOTTSDALE AZ
85260-6661
US

V. Phone/Fax

Practice location:
  • Phone: 480-478-6620
  • Fax: 480-478-6628
Mailing address:
  • Phone: 480-478-6620
  • Fax: 480-478-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MELVIN SHULL
Title or Position: OWNER
Credential: MD
Phone: 480-478-6620