Provider Demographics
NPI:1255635843
Name:RONALD SCHUBERT MD PLLC
Entity type:Organization
Organization Name:RONALD SCHUBERT MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-344-9749
Mailing Address - Street 1:PO BOX 23007
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98093-0007
Mailing Address - Country:US
Mailing Address - Phone:253-344-9749
Mailing Address - Fax:253-927-2627
Practice Address - Street 1:1811 MARINER CIR NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-3470
Practice Address - Country:US
Practice Address - Phone:253-344-9749
Practice Address - Fax:253-927-2627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty