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General NPI Number Information
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NPI Number | 1427476100
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Entity Type | Individual
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Provider Name | JOHN PAUL SHOUP M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 1520 WENTZVILLE PKWY
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City | WENTZVILLE
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State | MO
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Zip | 63385-3408
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Country | US
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Telephone | 636-497-4000
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Fax | 636-497-4001
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Provider Business Mailing Address
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Address Line | 1520 WENTZVILLE PKWY
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City | WENTZVILLE
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State | MO
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Zip | 63385-3408
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Country | US
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Telephone | 636-497-4000
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Fax | 636-497-4001
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2018-00418
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2019009766
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2019009766
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License Number State | MO
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