Provider Demographics
NPI:1477536514
Name:SCHUBERT, FREDERICK C (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:C
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 1:1700 E. 19TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058
Mailing Address - Country:US
Mailing Address - Phone:541-296-7760
Mailing Address - Fax:541-296-7619
Practice Address - Street 1:1700 E 19TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3317
Practice Address - Country:US
Practice Address - Phone:541-296-7760
Practice Address - Fax:541-296-7619
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14061207ZC0500X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8209132Medicaid
OR050906Medicaid
OR050906Medicaid
R0000ZBBWZMedicare ID - Type UnspecifiedMEDICARE GROUP
C52035Medicare UPIN