Healthcare Provider Details

I. General information

NPI: 1619437548
Provider Name (Legal Business Name): ALEXANDER JAY SCHUPPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 N 3RD AVE # 200
PHOENIX AZ
85013-4434
US

IV. Provider business mailing address

2910 N 3RD AVE # 200
PHOENIX AZ
85013-4434
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3181
  • Fax: 833-973-5424
Mailing address:
  • Phone: 602-406-3181
  • Fax: 833-973-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number79133
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: