Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 14880 | AZ |
NPI | 1093771784 |
---|---|
Provider Name | Mark Samuel Schubert |
First Address | Phoenix, AZ 85013-3421 |
Second Address | Phoenix, AZ 85013-3421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E78610 | (02) |