Provider Demographics
NPI:1942238241
Name:SCHUBART, PETER J (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:SCHUBART
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2512 SAMARITAN CT
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4002
Mailing Address - Country:US
Mailing Address - Phone:408-358-8272
Mailing Address - Fax:408-356-7779
Practice Address - Street 1:455 OCONNOR DR
Practice Address - Street 2:SUITE 370
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1633
Practice Address - Country:US
Practice Address - Phone:408-292-7202
Practice Address - Fax:408-297-2351
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG407292086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G407290Medicaid
CA330003744OtherRAILROAD MEDICARE PIN
CA330003744OtherRAILROAD MEDICARE PIN
CAA48335Medicare UPIN