Provider Demographics
NPI:1740218973
Name:SHUB, HARVEY ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:ALLEN
Last Name:SHUB
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 1:5425 S SEMORAN BLVD STE 6A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1777
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5425 S SEMORAN BLVD STE 6A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1777
Practice Address - Country:US
Practice Address - Phone:407-482-0052
Practice Address - Fax:407-482-0198
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30422208C00000X
FLME30422207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48919Medicare ID - Type Unspecified
FLD55511Medicare UPIN