Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 31072 | NC |
NPI | 1255315396 |
---|---|
Provider Name | Braden Alan Shoupe |
First Address | Dumfries, VA 22025-2050 |
Second Address | Apo, AE 09810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 13/02/2018 |