Provider Demographics
NPI:1164474011
Name:SCHUBERT, ERIC (DPM)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:SCHUBERT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5324 SPORTSMAN CLUB RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-8147
Mailing Address - Country:US
Mailing Address - Phone:614-395-3517
Mailing Address - Fax:866-244-0657
Practice Address - Street 1:2875 RAVINE WAY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3507
Practice Address - Country:US
Practice Address - Phone:614-395-3517
Practice Address - Fax:866-244-0657
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-3098-S213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2268102Medicaid
OHSC4053914Medicare ID - Type Unspecified
OH2268102Medicaid