Provider Demographics
NPI:1386614964
Name:SCHUBERT, BRUCE FRED (PA)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:FRED
Last Name:SCHUBERT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1208
Mailing Address - Street 2:
Mailing Address - City:DALHART
Mailing Address - State:TX
Mailing Address - Zip Code:79044
Mailing Address - Country:US
Mailing Address - Phone:806-249-8324
Mailing Address - Fax:806-249-8412
Practice Address - Street 1:201 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:DALHART
Practice Address - State:TX
Practice Address - Zip Code:79022
Practice Address - Country:US
Practice Address - Phone:806-249-8324
Practice Address - Fax:806-249-8412
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00540363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX458904Medicare UPIN