MEDICARE: DR. ALEXANDER JAY SCHUPPER MD

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	207T00000X	Neurological Surgery Physician	79133	AZ
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1619437548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER JAY SCHUPPER MD

Provider Business Mailing Address
First Line	:	2910 N 3RD AVE # 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-4434
Country	:	US
Telephone Number	:	602-406-3181
Fax Number	:	833-973-5424

Provider Business Practice Location Address
First Line	:	2910 N 3RD AVE # 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-4434
Country	:	US
Telephone Number	:	602-406-3181
Fax Number	:	833-973-5424

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	05/26/2026

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