Provider Demographics
NPI:1467430934
Name:SHUBERT, RONALD ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ANTHONY
Last Name:SHUBERT
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 1:3501 TUSCARAWAS ST W
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-5640
Mailing Address - Country:US
Mailing Address - Phone:330-453-3099
Mailing Address - Fax:330-453-3240
Practice Address - Street 1:3501 TUSCARAWAS ST W
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-5640
Practice Address - Country:US
Practice Address - Phone:330-453-3099
Practice Address - Fax:330-453-3240
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-02-8483-S207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0223663Medicaid
OH0373512Medicare PIN
OHA74029Medicare UPIN