Shupak, Raymond Patrick
Shupak, Raymond Patrick is an individual health care provider with primary practice located at 1500 South Main Street Jps Hospital Dept Of Omfs, Fort Worth TX 76104. He recently has 2 registered licenses in different health care specialties including Dental Providers / Oral and Maxillofacial Surgery, Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery. Dental Providers / Oral and Maxillofacial Surgery is his primary health care specialty. Shupak, Raymond Patrick can be contacted via phone (817) 702-5595.Contact Information
Primary practice address
1500 South Main Street Jps Hospital Dept Of Omfs
Fort Worth TX 76104
Phone: (817) 702-5595
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | DS038719 | Pennsylvania |
| Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery | 204E00000X | S4567 | Texas |
| Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery | 204E00000X | MD461668 | Pennsylvania |
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 35670 | Texas |
Profile Details
| NPI number | 1962798462 |
|---|---|
| LBN Legal business name | Shupak, Raymond Patrick |
| Credentials | DMD, MD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 22nd, 2011 |
| Last updated | May 24th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962798462 | NPPES |
| Pennsylvania | MEDICAID | 1029564820001 |
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