Provider Demographics
NPI:1134114606
Name:SCHUBRING, LEONARD WESLEY (PA C)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:WESLEY
Last Name:SCHUBRING
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 411875
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32941-1875
Mailing Address - Country:US
Mailing Address - Phone:321-794-0309
Mailing Address - Fax:
Practice Address - Street 1:1381 S PATRICK DR
Practice Address - Street 2:FAMILY PRACTICE
Practice Address - City:PATRICK AFB
Practice Address - State:FL
Practice Address - Zip Code:32925-3606
Practice Address - Country:US
Practice Address - Phone:321-794-0309
Practice Address - Fax:321-494-8980
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2010-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001109363A00000X
FLPA2879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UAD-000Medicare UPIN