Provider Demographics
NPI:1093771784
Name:SCHUBERT, MARK SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:SAMUEL
Last Name:SCHUBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W CLARENDON AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3421
Mailing Address - Country:US
Mailing Address - Phone:602-277-3337
Mailing Address - Fax:602-277-3330
Practice Address - Street 1:300 W CLARENDON AVE
Practice Address - Street 2:STE 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3421
Practice Address - Country:US
Practice Address - Phone:602-277-3337
Practice Address - Fax:602-277-3330
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14880207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E78610Medicare UPIN
AZ03WCHHZ02Medicare ID - Type Unspecified