Provider Demographics
NPI:1902859457
Name:SHUBE, SAMUEL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ALAN
Last Name:SHUBE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2700 UNIVERSITY SQUARE DRIVE
Mailing Address - Street 2:RADIOLOGY ASSOCIATES OF TAMPA
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5513
Mailing Address - Country:US
Mailing Address - Phone:813-251-5822
Mailing Address - Fax:813-254-4597
Practice Address - Street 1:2700 UNIVERSITY SQUARE DRIVE
Practice Address - Street 2:RADIOLOGY ASSOCIATES OF TAMPA
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5513
Practice Address - Country:US
Practice Address - Phone:813-251-5822
Practice Address - Fax:813-254-4597
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME00778882085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256564100Medicaid
AL118721Medicaid
FLE2332RMedicare PIN
F68571Medicare UPIN
FL2332QMedicare PIN
FLE2332NMedicare PIN
FL256564100Medicaid
FLE2332Medicare PIN
FLE2332TMedicare PIN