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General NPI Number Information
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NPI Number | 1285745158
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Entity Type | Individual
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Provider Name | STEPHEN R SHUPUT MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 43314 BANDA TER
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City | FREMONT
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State | CA
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Zip | 94539-5660
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Country | US
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Telephone | 800-991-6704
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Fax | 408-444-8845
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Provider Business Mailing Address
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Address Line | 43314 BANDA TER
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City | FREMONT
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State | CA
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Zip | 94539-5660
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Country | US
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Telephone | 800-991-6704
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Fax | 408-444-8845
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD27419
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 82-169038-1205
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G52161
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License Number State | CA
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