Provider Demographics
NPI:1659318335
Name:SHUBROOKS, SAMUEL J JR (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:SHUBROOKS
Suffix:JR
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15 LORRAINE CIR
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1417
Mailing Address - Country:US
Mailing Address - Phone:617-632-9204
Mailing Address - Fax:
Practice Address - Street 1:1 DEACONESS RD ,BAKER 4
Practice Address - Street 2:BETH ISRAEL DEACONESS MEDICAL CTR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-632-9214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA29394207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAC57302Medicare UPIN