Provider Demographics
NPI:1578797023
Name:EDWARD E. SHUBERT M.D., P.A.
Entity Type:Organization
Organization Name:EDWARD E. SHUBERT M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ELMER
Authorized Official - Last Name:SHUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-440-1500
Mailing Address - Street 1:17070 RED OAK DR.
Mailing Address - Street 2:#405
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2616
Mailing Address - Country:US
Mailing Address - Phone:281-440-1500
Mailing Address - Fax:281-440-0052
Practice Address - Street 1:17070 RED OAK DR.
Practice Address - Street 2:#405
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2616
Practice Address - Country:US
Practice Address - Phone:281-440-1500
Practice Address - Fax:281-440-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8173207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0329542-01Medicaid
TX0A3934Medicare PIN
TX0329542-01Medicaid